Split-thickness Graft Research Articles

Reconstruction of scalp defects in electrical burns: Challenges and options

Introduction: Electrical burn injury in India comprises a fair percentage of overall burn injuries, and they cause significant morbidity. Reconstruction of scalp defects often poses challenges to the plastic surgeon regarding the timing of surgery, choice of reconstruction, and postoperative management. The objective of this article is to throw light on various options for reconstruction of scalp defects as the involvement leads to significant morbidity. Materials and Methods: The study was conducted at a tertiary burn care unit. The period of this study was from 2016 to 2019. Retrospective analysis was done. Results: In this study, retrospective analysis of 40 cases of scalp burns was evaluated from 2016 to 2019. Out of these, 6 patients were managed with primary suturing, 8 patients underwent split-thickness skin graft, 24 patients required local flaps, and 2 patients were managed with extracorporeal radial forearm flap. There were no major complications. Minor complications like wound infection were seen in five of the local flap patients which were managed with antibiotics and regular dressing. Two patients had partial flap loss which was revised and managed conservatively. All flaps healed well. There was hair loss patch evident in patients where split-thickness graft was used. Conclusion: Thorough debridement of the wound is necessary in electrical burns. Smaller scalp wounds can be managed with split-thickness skin graft and local flaps, but larger defects should be managed with distant flaps and free flaps. This study shows that local flaps are the ideal choice for reconstruction of scalp defects due to their easy availability, minimal complications, and acceptable cosmesis.

Reverse Sural Artery Flap for Dorsum of Foot Reconstruction

Loss of skin over the dorsum of foot is a common clinical entity. Infection, trauma, and vascular disease represent the most common etiological factors. Salvage of foot in these cases has a bearing upon the quality of life of the patient. The reconstruction process is often complex and varied as per exigencies. Reverse sural artery flap is an easy and reliable option for reconstruction of dorsum of foot defect. Reverse sural artery draws its vascularity from the communication of the peroneal artery and the median sural artery. The flow of the flap is from the distal to the proximal and represents an elegant option for dorsum of foot. We have described the peninsular variant of the reverse sural artery. The coverage of the defects of the dorsum of foot in trauma can be performed either immediately if the wound conditions are favorable or we may have to delay the procedure of definitive cover by a few days till the wound conditions improve by use of vacuum-assisted closure (VAC) application. Split thickness graft, reverse sural artery flap, and free flaps provide safe and viable options for dorsum of foot defects. Reverse sural artery is reliable option in the armamentarium of the reconstructive surgeon. Gaba S, Sharma RK, John JR, et al. Reverse Sural Artery Flap for Dorsum of Foot Reconstruction. J Foot Ankle Surg (Asia Pacific) 2021;8(1):28–32.

A Novel Technique of Collagen Application over Meshed Split Thickness Graft for Wound Coverage

A Novel Technique of Collagen Application over Meshed Split Thickness Graft for Wound Coverage

Dehydrated Human Amnion Chorion Membrane as Treatment for Pediatric Burns.

Objective: Pediatric burns are a major source of injury and in the absence of adequate care can lead to lifelong functional loss and disfigurement. While split thickness skin autografts are the current standard of care for deep partial and full-thickness burns, this approach is associated with considerable morbidity. For this reason, alternative skin substitutes such as allografts have gained interest.Approach: In the present study, we present a case series of 30 children with various types of burns treated with dehydrated human amnion chorion membrane (dHACM).Results: We show that treatment with dHACM is associated with an excellent rate of healing comparable to split thickness skin grafts with less rate of hypertrophic scar and contracture.Innovation: Treatment with dHACM is particularly attractive as it consists of many tissue regenerative factors, such as growth factors and immune modulators, thus it will reduce the risk of scaring.Conclusion: While dHACM is associated with an increased upfront cost, treating patients with small to moderate-sized burns with dHACM in their regional centers works to decrease downstream costs such as management of prolonged pain from donor-site morbidity, revisional surgeries from scar and contractures of split thickness grafts, and avoiding the cost of transfer to higher level centers of care. Our findings challenge the current standard of care, suggesting that dHACM provides an alternative to the current use of split thickness skin grafting and is a safe, feasible, and potentially superior substitute for the management of small to moderate total body surface area partial and full-thickness pediatric burns.

The Utilization of a Nitric Oxide Generating Serum for Improving Vascularity in Wound Healing

Introduction: Poor vascularity in injured or operated tissue predisposes the patient to poor healing. Many disease states such as diabetes mellitus, atherosclerosis, and Raynaud’s Disease exhibit delayed or compromised healing. Post-radiated tissue is another example of poor healing potential. Any surgical wound, local, regional, or free flap reconstruction, can see delayed healing or lack of healing with poor blood supply. Nitric oxide (NO) is an endothelial cell, endogenously produced, free radical gas. It is a potent vasodilator and inhibitor of platelet aggregation. A NO producing serum has recently been developed (Pneuma Nitric Oxide, Austin Texas). This is the first study to examine the potential efficacy of a NO generating serum in the wound healing population. Objective: The objective of this study is to examine the potential efficacy of a Nitric oxide generating serum in the wound healing patient population Method: Twenty-five patients were studied in two centers between December 2018 and June 2020. Prior to utilizing NO serum, a double-blind, placebo controlled (glycerin) safety study was performed on 10 patients. There were no allergic or irritation reactions to NO serum in this population. NO serum was applied to non-healing diabetic ulcers, vascular compromised non-healing wounds, surgical incisions, split thickness grafts, full thickness grafts, regional and free flaps. Patients were followed weekly and photographed regularly to monitor healing until total healing was reached. Results: Without exception, the study population showed a more rapid and improved quality of healing in the wounds that were treated with Nitric oxide generating serum as compared to control sites. Rapid reepithelialization, wound contraction, less bruising and edema were commonly seen. Neo-vascularization was more rapid in surgical flap cases. Burn wounds healed dramatically. Conclusion: This study shows the benefits of a Nitric oxide- generating serum in the wound healing patient population. The vasodilatory and capillary recruitment capabilities of Nitric oxide are hypothesized as key factors leading to this improved healing. NO is also paramount in the differentiation and proliferation of fibroblasts, keratinocytes, monocytes, and macrophages. Topically, NO has also been shown in the literature to have strong anti-bacterial, anti-fungal, and anti-viral roles. NO serum is a valuable addition to the armamentarium of wound healing protocols.

Staged surgical management of an extensive penoscrotal and perineal microcystic lymphatic malformation in an adolescent male

Abstract This case reports details a successful approach to the surgical management of an extensive penoscrotal microcystic lymphatic malformation in an adolescent male. The patient had staged total excision of skin and subcutaneous tissue and reconstruction was achieved with a combination of thick and thin split thickness grafts.

Matriderm and Split-Thickness Skin Graft for Burn Contractures of the Hands

Scar contracture and hypertrophic scar of the hands are common late complications encountered in burn patients which result in imperfect wound healing. Burns often cause full-thickness skin defects which should be ideally reconstructed with full-thickness skin grafts or flaps. In burn victims with large TBSA these options are limited due to the lack of sufficient donor site. Nonetheless, the dermis can be partially reconstructed using split-thickness grafts which have become the mainstay of treatment in extensive burns. Although the split-thickness skin grafts are versatile, their use on the face or on the hands has undesirable outcomes such as poor color match, poor skin elasticity, graft contracture with limitation of joint movement and hypertrophic scars, due to a discontinuous healthy dermal layer. To compensate for this, numerous artificial dermal substitutes have been developed such as Matriderm.

Effective safe technique for surgical canalization of congenital aural atresia with the same session reconstruction of the meatus and TM by split thickness graft (Autograft)

BackgroundThis case series study is to evaluate the results of our technique for correction of congenital aural atresia. Seventeen patients were done from 2015 till 2018, 4 cases bilateral and 13 unilateral. Surgical canalization of congenital aural atresia with the same session reconstruction of the meatus and TM by split thickness graft (Autograft) was done. Follow-up is done weekly for 3 months then every 2 weeks for another 3 months, till we establish the formation of EAC. All cases were followed up for at least 1 year.ResultsAll patients have now established skin limned external canal. There is no facial nerve or dural or sigmoid injuries. Only one case TMJ was exposed during the surgical procedure. One case had postauricular wound gapping and another one was complicated after 1 year by stenosis. All patients improved subjectively in speech and language postoperatively except one case who has autism and still undertreatment.ConclusionCongenital aural atresia is a challenging surgery. Surgical canalization with the same session grafting of the drum and the formed cavity by split thickness skin graft is effective with minimal minute rate of complications and recurrence.

Orbital exenteration: Symptoms, indications, tumour localizations, pathologies, reconstruction, complications and survival

ObjectiveThis study aims to evaluate malignant and benign diseases that lead to orbital exenteration. PatientsFrom December 1999 to September 2017, patients undergoing orbital exenteration were included in this retrospective study. All of them were evaluated on clinical symptoms, indications, tumour localizations, pathologies, reconstruction techniques, complications, recurrences, and survival. ResultsOf the 205 patients enrolled in this study, 94 had a carcinoma, 73 melanoma, 9 a sarcoma, 14 some other malignant disease, and 15 a benign medical condition. Sixteen patients underwent reconstruction using a local eyelid skin flap (7.8%), 6 with a split-thickness graft (2.9%), 144 with a local flap (70.2%), and 25 with a microvascular graft (12.2%), whereas 14 patients did not undergo reconstruction (6.8%). The most common complications were wound dehiscences (25 cases), pain (17 cases), and partial flap necroses (13 cases). Moreover, 62% of the patients were treated with different facial prostheses or artificial eyes. Given these results, it appears that lymph nodes and distant metastases, as well as lymphatic invasion into vessels, perineural invasion, and non-cleared resection margins, seem to affect overall survival after orbital exenteration. ConclusionDifferent reconstruction techniques can be used to provide the patient with maximum functionality and aesthetics after orbital exenteration. Individual concepts should be discussed at the beginning of the treatment. Using primary reconstruction and providing osseointegrated implant-retained prostheses remain the gold standard.

Clinical Results of Ear Elevations in Patients with Microtia Using Skin Grafts from Three Donor Sites: A Retrospective Study.

Skin grafts, frequently used for ear elevation in ear reconstructions, may suffer from color mismatches, scar hypertrophy, secondary contraction, and auricular sulcus depth differences. To determine the most suitable donor area, we compared the contralateral postauricular area, groin, and scalp as potential donor sites. Since 2008, we have used three donor sites for obtaining skin grafts used in ear reconstructions. Full-thickness groin skin, split-thickness grafts from the scalp, and contralateral postauricular and groin composite full-thickness skin grafts were used in 202, 231, and 195 patients, respectively. Photographic assessments were used to assess color matching, sulcus depth, cranioauricular angle symmetry, and flatness of the skin grafts; surgical complications were also documented. Among the three donor sites, there were no significant differences in the color matching scores (p = 0.456). The scalp donor scores had significantly lower mean scores for sulcus depth and symmetry and for graft flatness scores than the other donor sites. The assessment scores between the groin and postauricular donor groups were similar. Each donor site was associated with some surgical complications. However, postauricular skin, when combined with groin skin, demonstrated the best cosmetic results and the fewest complications. All three donor sites are viable options for skin graft donor sites in ear elevation surgeries. Although the advantages and disadvantages of each site should be explained to the patient, the ultimate donor site selection may be determined according to patient and surgeon preferences. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of split skin thickness graft survival in diabetic and non-diabetic ulcer

Background: Split skin grafting is widely used surgical procedure for the treatment of ulcers. Graft survival depends on number of factors like vascularity, wound infection etc, diabetes is associated with endothelial dysfunction, neuropathy, wound infection which collectively affect the graft survival. Objective of this study was to compare the amount of graft uptake, the post-operative complications and survival of split thickness skin graft in diabetic and non-diabetic ulcer.Methods: In our prospective comparative study total 112 patients with ulcer were included of which 56 were diabetic and 56 were non-diabetic. All of t7hem underwent split skin grafting as part of their wound management. Comparison was made between two groups in terms of amount of graft uptake, post-operative wound infection, revisional surgery, donor site infection.Results: Compared with non-diabetics, diabetics have significantly less graft uptake (p<0.001). out of 56 patients in diabetic group 4 (66.7%) underwent revisional surgery, out of 56 patients in non-diabetic group 2 (33.3) patients underwent revisional surgery (p value is <0.68) which is statistically insignificant. 3 (60%) out of 56 in diabetic group developed post-operative graft infection, 2 (40%) out of 56 in non-diabetic group developed graft infection (p=1, not significant). One patient in the study developed donor site infection. Among 112 cases, only 1 case had donor site infection with diabetic.Conclusions: Diabetes is associated with poor graft uptake and post-operative complication rates in patients undergoing split skin grafting.

727 Use of a Biodegradable Dermal Matrix in Conjunction with Meshed and Sprayed Autologous Cell Suspension with a Vacuum Assisted Dressing Achieved Limb Salvage in a 73 Year Old with Deep Full Thickness Burns Despite Exposed Tendon and Bone

Abstract Introduction Deep Full thickness burns require tangential excision of the burned tissues down to viable tissue. This often leaves exposed muscle, tendon and bone. Coverage of these areas is vital to limb salvage. Multiple modalities are necessary with these type of patients, such as, dermal matrix graft, split thickness skin graft, sprayed autologous cell suspension (ACS) and wound vacuum therapy(VAC). A dermal matrix provides a scaffold for tissue and vascular en growth that is suitable for accepting a skin graft and also provides a layer between the muscle, tendon, bone and the skin graft which improves movement and produces a more pliable graft. Biodegradable temporizing matrix(BTM), produced by PolyNovo Ltd, was used to cover the muscle, bone and tendon. This product has a silicone backing which can be delaminated once it has matured with tissue and vascular en growth for auto grafting. A combination of a wide meshed skin graft at 3:1 ratio and a sprayed ACS allows for faster healing and less donor site usage which decreases the overall wound burden. Methods A 73 y/o male with total body surface area burn of 24 % suffered deep full thickness burns to the bilateral lower legs. He underwent multiple debridements with management of the right leg with irrigating wound vacuum therapy. The deeper right leg had a wound base with that consisted of muscle from the thigh down onto the foot with exposed tendons and anterior tibial bone. The open wounds to the right leg were grafted with BTM for dermal substitute coverage. Once the BTM was mature it was delaminated, and the wound surface was covered with a 3:1 ratio split thickness skin graft (STSG) and sprayed on autologous cell suspension. This resulted in using less donor skin than a 1.5 or 2:1 meshed graft STSG which decreased his wound burden. Donor sites were also sprayed with ACS. Results We had nearly 100% take of the STSG and sprayed autologous suspension epidermal graft. There was a small area over the patella tendon where the BTM did not incorporate. This is though to be because of lack of immobilization of his knee and a pseudomonal infection. Donor sites healed faster and there were minimal open areas to the graft POD 11 excluding the patella area. Conclusions BTM can be used to provide a suitable dermal substitute in complex wounds when muscle, tendon and/or bone are exposed. Immobilization of the joints is necessary to allow the tissue en growth into the dermal matrix. Wide meshed graft with sprayed ACS can be used with good results with wound vacuum therapy. Decreased wound burden and time to heal open wounds of the graft and donor sites. Applicability of Research to Practice Use of a dermal matrix, wide mesh split thickness graft and sprayed epidermal ACS with wound vacuum therapy is a good option for limb salvage when vital structures are exposed.

Clinical trial to compare between different dressing methods on split thickness graft donor site (conventional method VS Ca alginate Vs Hydrocolloid sheet)

Abstract Background According WHO Egypt has high incidence in RTA and burn. Controversy between studies and reviews on the best dressing on donor site, while evidence support the use of moist wound dressings other centers believe that the impregnated gauze is cost effective. Objective Comparison between 3 types of dressings: The Conventional method (Vaseline gauze), Calcium alginate and Hydrocolloid sheets to determine which donor-site dressings are associated with the best outcomes for faster healing rate, less Pain, decreased Infection rate, healing quality and cost-effectiveness. Patients and Methods This study was conducted on 60 patients 35 males (58.33%) and 25 females (41.67%) in Ahmed Maher Teaching hospital divided into 20 patients in each, the conventional by Vaseline gauze group, the hydrocolloid using group and the Ca alginate group. Results The hydrocolloid showed highly significant overall results in faster epithilization and healing rate with mean 9.35 days ± 1.8 days and significant pain reduction post operatively and comfort during dressings and it was satisfactory in the reduction in change frequency as most patients healed between 7 – 10 days and in most cases the requirement for dressing change was every 5 days. Conclusion Modern wound dressings should become the standard of care in Egyptian burn centers and hydrocolloid is advised when multiple reharvesting for huge skin defects and increase satisfaction with considerable cost effectiveness. Vaseline gauze showed the worst results, but cost effectiveness by direct method is doubted if compared by the indirect and global cost of analgesics, hospital stay and medical stuff burden of dressing frequency.

Efficacy of ultrathin epidermal grafting followed by narrow band ultraviolet B therapy for stable vitiligo: a novel therapy

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong>Different surgical techniques in the form of tissue or cellular grafting procedures are used alone or in combination with narrow band ultraviolet B (NBUVB) to treat stable vitiligo resistant to medical treatment. The aim of the study was to assess the cosmetic results obtained with combination therapy of ultrathin split-thickness skin grafts and adjuvant NBUVB therapy in resistant, stable vitiligo.</p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>Forty patients of stable vitiligo were treated with ultrathin split-thickness grafting and the patients were then put on NBUVB therapy. Extent of repigmentation and final cosmetic outcome at the recipient as well as donor sites were assessed<span lang="EN-US">.<strong></strong></span></p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>The initial evidence of repigmentation was noted in the second week after starting NBUVB. Results showed 85% of patients had more than 90% repigmentation and the overall cosmetic results at the recipient site was good to excellent in 90% patients at the end of NBUVB treatment. Perigraft halo of depigmentation was seen in five patients (12%) on the recipient site. Hypertrophic scarring was seen in two patients at the donor site.</p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>Ultrathin split-thickness skin grafting, when combined with NBUVB therapy, leads to better cosmetic outcome with faster onset of repigmentation in resistant and stable vitiligo.</p>

Lipoconstruct surface topography grating size influences vascularization onset in the dorsal skinfold chamber model

After skin tissue injury or pathological removal, vascularization timing is paramount in graft survival. As full thickness skin grafts often fail to become perfused over larger surfaces, split-thickness grafts are preferred and can be used together with biomaterials, which themselves are non-angiogenic. One way of promoting vascular ingrowth is to “pre-vascularize” an engineered substitute by introducing endothelial cells (ECs). Since it has been previously demonstrated that surface structured biomaterials have an effect on wound healing, skin regeneration, and fibrosis reduction, we proposed that a microvascular-rich lipoconstruct with anisotropic topographical cues could be a clinically translatable vascularization approach. Murine lipofragments were formed with three polydimethylsiloxane molds (flat, 5 µm, and 50 µm parallel gratings) and implanted into the dorsal skinfold chamber of male C57BL/6 mice. Vascular ingrowth was observed through intravital microscopy over 21 days and further assessed by histology and protein identification. Our investigation revealed that topographical feature size influenced the commencement of neovascular ingrowth, with 5 µm gratings exhibiting early construct perfusion at 3 days post-operation, and 50 µm being delayed until day 5. We therefore postulate that surface structured lipoconstructs may serve as an easily obtained and produced construct suitable for providing soft tissue and ECs to tissue defects. Statement of SignificanceSkin graft failures due to inadequate or uneven perfusion frequently occur and can be even more complicated in deep, difficult to heal wounds, or bone coverage. In complex injuries, biomaterials are often used to cover bone structures with a standard split thickness graft; however, perfusion can take up to 3 weeks. Thus, any means to promote faster and uniform vascularization could significantly reduce healing time, as well as lower patient down-time. As pre-vascularized constructs have reported success in research, we created a cost-efficient, translatable method with no additional laboratory time as adipose tissue can be harvested and used immediately. We further used surface topography as an aspect to modulate construct perfusion, which has been reported for the first time here.

Vacuum-assisted Closure in Integration of Skin Graft Over Scalp Wounds: A Randomised Control Trial.

To compare outcome of split thickness graft with and without vacuum-assisted closure over the scalp soft tissue defects in terms of graft take and complications. Randomised controlled trial. Department of Plastic Surgery, Jinnah Burns and Reconstructive Surgery Centre, Lahore, from June 2017 to June 2018. Patients with scalp soft tissue defects were recruited for the study. Patients with history of poly trauma, hypertension and diabetes mellitus were excluded. Patients were randomly divided into two groups by balloting lottery method. In group A, simple dressing were done after split thickness skin graft; and into group B, VAC dressing was applied after split thickness skin graft. Outcome variables (graft take and complications rate at recipient site) were assessed clinically at 2 weeks and analysed by Chi-square test with p-value <0.05 was taken as significant. Mean age of 120 patients was 33.44 ±14.65 years. Graft take was seen in 24 (40.0%) patients in group A and in 56 (93.3%) patients in group B (p = 0.0001). Seroma was recorded in eight (13.3%) in group A (simple dressing) patients and one patient (1.67%) in group B (VAC dressing, p = 0.015), hematoma was seen in 04 (6.67%) versus 0 (0.0%), respectively (p = 0.042) and graft edge dehiscence in 03 (5.0%) versus 0 (0.0%), respectively (p = 0.079). Outcome of split skin graft over scalp soft tissue defects with VAC dressing is better than simple dressing in terms of graft take and complications rate.

Comparing different modalities of managing postburn axillary contracture

Introduction: Axillary postburn scar contracture is a challenging problem to the reconstructive surgeon owing to the wide range of abduction that should be achieved. The aim of this study is to highlight the various management options used in managing axillary contractures in our hospital and to minimize the complications commonly encountered. Aims and Objective: The aim and objective of this study is (1) to evaluate different options for postburn axillary contracture treatment, (2) the functional outcome of different treatment methods, and (3) late squeals of treatment. Materials and Methods: It is a prospective study which was conducted at the department of plastic surgery. Axillary contracture was released and resurfaced using split skin graft and/or with different types of flaps, including the Single Z plasty, Multiple Z plasty, Five flap plasty, Local fasciocuteneous flap, Propeller flap, and Parascapular flap. Results: Eighteen patients were operated. Surgical treatment included split-thickness skin graft in five cases, square flap in three cases and square flap with split thickness graft in two cases, Multipe Z-plasties in two cases and Multipe Z plasty with split-thickness graft in one case, Parascapular flaps with split thickness graft in two cases, while five flap plasty in three cases. Conclusion: Mean degree of abduction is maintain or increased in follow-up (after 6 month) is Square flap, Multiple Z plasty, five flap plasty, and Parascapular flap. Mean degree of abduction is decreased in split thickness graft in follow-up (after 6 month).

A comparative clinical study of collagen and paraffin gauze dressing on skin donor site

Background: Split skin grafting (SSG) is a commonly performed plastic surgical procedure. It is done to cover wounds, defects from excision of cutaneous lesions, donor sites of fascio-cutaneous flaps. The harvest of a split thickness skin graft causes a partial thickness injury. Complete re-epithelialization occurs in 10-14 days, although the rate may be affected by the local wound environment. However, tissue desiccation and infection can convert a partial thickness injury to a full thickness loss. Aims and Objectives: The purpose of the study was to determine the best method of dressing the donor site split-thickness graft between conventional paraffin gauze dressing and collagen-based dressings with respect to the rate of healing, pain, secretion, infection, and cost. Settings and Design A hospital based Non-Randomized control trial was conducted in a tertiary hospital setup in Manipur, India, for a period of 2 years. This study was done on 60 patients who underwent split skin graft procedure. Materials and Methods: The selected sample will be divided into two groups. The donor site dressing was done in two different ways. One was dressed with collagen sheet and the other with paraffin gauze dressing. The two groups were compared on the basis of post-operative pain, complication, and healing. Statistical analysis Statistical analysis was done by using IBM SPSS Version 21 for windows. Descriptive statistics such as mean, proportion, percentage were used to present the result. Chi square test was used to see the association of proportions. Student's t- test and repeated ANOVA were used for the continuous variables. P-value Conclusion: In this study it was found that dressing the donor site for split-thickness graft with collagen-based dressings gave better results with respect to the rate of healing and post-operative pain scores than conventional paraffin gauze dressing.

Reliability of the Estimation of the Take of Split Thickness Graft by the Observation Method

Introduction: Split thickness skin grafts are frequently employed to provide biological cover for extensive wounds. The take of the skin graft is traditionally estimated by observation and recorded as a percentage. The intent of this study was to ascertain the reliability of the observation method in comparison with the Image J digital programme. Materials and Methods: The study was a longitudinal study conducted on the wards of the National Reconstructive Plastic Surgery and Burns Centre (NRPSBC) at the Korle Bu Teaching Hospital (KBTH) on patients who were admitted during the period of the study with wounds who received split skin grafts. Image J®, an image analysis program, was employed in the calculation of the take of the grafts. These were compared to values obtained by estimation by observation. Results: There was no statistically significant difference between the estimation of graft take, made by observation and using Image J® digital programme. Conclusion: The estimation of graft take by observation is an acceptable practice.

Simultaneous two-layer harvesting of scalp split-thickness skin and dermal grafts for acute burns and postburn scar deformities.

BackgroundThe scalp, an excellent donor site for thin skin grafts, presents a limited surface but is rich in stem cells. The purpose of this study was to test a double harvesting procedure from the scalp and to evaluate the capacity of the dermal layer.MethodsTwo layers corresponding to a split-thickness skin graft (SSG) and a split-thickness dermal graft (SDG) were harvested from the scalp using a Zimmer dermatome during the same procedure. Healing of the scalp donor site, reason for recipient site grafting, and the percentage of graft loss were evaluated.ResultsFourteen patients, comprising six men and eight women with a mean age of 34.2 years, were treated according to our protocol. The most common reason for a recipient site graft was a postburn scar deformity (10/14 patients). The mean area of scalp SSGs was 151.8 cm2. The mean area of scalp SDGs was 88.2 cm2. The mean healing time of scalp donors was 9.9 days. The only donor complication was a tufted scar deformity.ConclusionsSkin defects in the scalp of donors healed faster and led to less scarring than defects at other donor sites. Scalp SDGs needed 10 days for adequate epithelization. The scalp was the best donor site for SSGs and SDGs for burn reconstructive patients.