Split-thickness Skin Graft Research Articles

In vivo efficacy proof of concept of a large-size bioprinted dermo-epidermal substitute for permanent wound coverage.

Introduction: An autologous split-thickness skin graft (STSG) is a standard treatment for coverage of full-thickness skin defects. However, this technique has two major drawbacks: the use of general anesthesia for skin harvesting and scar sequelae on the donor site. In order to reduce morbidity associated with STSG harvesting, researchers have developed autologous dermo-epidermal substitutes (DESs) using cell culture, tissue engineering, and, more recently, bioprinting approaches. This study assessed the manufacturing reliability and in vivo efficacy of a large-size good manufacturing practice (GMP)-compatible bio-printed human DES, named Poieskin®, for acute wound healing treatment. Methods: Two batches (40cm2 each) of Poieskin® were produced, and their reliability and homogeneity were assessed using histological scoring. Immunosuppressed mice received either samples of Poieskin® (n = 8) or human STSG (n = 8) immediately after longitudinal acute full-thickness excision of size 1 × 1.5cm, applied on the skeletal muscle plane. The engraftment rate was assessed through standardized photographs on day 16 of the follow-up. Moreover, wound contraction, superficial vascularization, and local inflammation were evaluated via standardized photographs, laser Doppler imaging, and PET imaging, respectively. Histological analysis was finally performed after euthanasia. Results: Histological scoring reached 75% ± 8% and 73% ± 12%, respectively, displaying a robust and homogeneous construct. Engraftment was comparable for both groups: 91.8% (SD = 0.1152) for the Poieskin® group versus 100% (SD = 0) for the human STSG group. We did not record differences in either graft perfusion, PET imaging, or histological scoring on day 16. Conclusion: Poieskin® presents consistent bioengineering manufacturing characteristics to treat full-thickness cutaneous defects as an alternative to STSG in clinical applications. Manufacturing of Poieskin® is reliable and homogeneous, leading to a clinically satisfying rate of graft take compared to the reference human STSG in a mouse model. These results encourage the use of Poieskin® in phase I clinical trials as its manufacturing procedure is compatible with pharmaceutical guidelines.

Negative Pressure Wound Therapy (NPWT) after Hybrid Reconstruction of Occipital Pressure Sore Using Local Flap and Skin Graft.

Background and objectives: Pressure sores are a common medical burden among patients, particularly those who are bedridden or frail. Surgical management of occipital pressure sores poses unique challenges due to limited elasticity and the spherical shape of the scalp. This study aims to evaluate the efficacy and safety of a novel reconstruction method utilizing a local transpositional flap and split-thickness skin graft with negative pressure wound therapy (NPWT) for occipital pressure sore treatment. Material and methods: A retrospective analysis was performed on patients with occipital pressure sores who underwent hybrid reconstructions using a local flap and split-thickness skin graft in conjunction with NPWT. Surgical outcomes, including flap survival rate, graft take percentage, and complications, were assessed. A comparative analysis was performed between the NPWT group and the conventional dressing group. Results: The NPWT group (n = 24) demonstrated a significantly higher mean graft take percentage at postoperative day 14 compared with the conventional dressing group (n = 22) (98.2% vs. 81.2%, p < 0.05). No significant difference in flap survival rate was observed between the two groups. Conclusions: As the aging population continues to grow, occipital pressure sores have gained significant attention as a crucial medical condition. The innovative surgical method incorporating NPWT offers an efficient and safe treatment option for patients with occipital pressure sores, potentially establishing itself as the future gold standard for managing this condition.

The Application of MatriDerm in Soft Tissue Defects with Bone Exposure

Background Treatment of patients with post-traumatic severe and chronic wounds poses many challenges. A large number of dermal analogs have been invented in an effort to overcome these challenges. Matriderm, a biosynthetic dermal analog, is made from bovine collagen and elastin. The aim of our study was to prove the effectiveness of MatriDerm® combined with skin grafting versus skin grafting alone in these difficult-to-heal wounds.&#x0D; Material and Methods: Twenty-two patients with post-traumatic defects with bone exposure and chronic wounds treated in the Clinic of Plastic Reconstructive and Aesthetic Surgery of the University Hospital “St. George” were included in this prospective study. The mean age of the patients was 58 years. The patients were divided into two groups: the experimental and the control group. The patients in the experimental group received a Matriderm appliance and a split-thickness skin graft, while those in the control group received only a split-thickness skin graft. All patients gave their informed consent to participate in the study.&#x0D; Results: The hospitalization period in the experimental group was 3 weeks and 5 days and in the control group 8 weeks. The period of complete healing was shorter in the experimental group patients (5 weeks) compared with control group patients (9 weeks) with a difference reaching statistical significance (P&lt;0.05). Matriderm enables effective healing and improves elasticity in the treatment of patients with post-traumatic severe and chronic wounds.&#x0D; Conclusions: With our study, we confirm the evidence of the clinical use of MatriDerm® technology in the healing of soft tissue wounds and prove the effectiveness of combining MatriDerm® and skin grafting for the first time. Moreover, we observed a reduction in wound contraction and an improvement in elasticity, quality of scar tissue, and dermal architecture.

Successful reconstruction of full-thickness skin defects in a swine model using simultaneous split-thickness skin grafting and composite collagen microstructured dermal scaffolds.

Reconstitution of normal skin anatomy after full-thickness skin loss may be accomplished using a combination of a dermal regeneration template (DRT) and a split thickness skin graft (STSG). However, because of the relatively low rate of cell infiltration and vascularisation of currently available DRTs, reconstruction is almost always performed in a two-step procedure over the course of several weeks, resulting in multiple dressing changes, prolonged immobilisation and increased chance of infection. To mitigate the potential complications of this prolonged process, the collagen-based dermal template DermiSphere™ was developed and tested in a single-step procedure wherein DermiSphere and STSG were implanted simultaneously. When evaluated in a porcine, full thickness, excisional wound model, DermiSphere successfully supported simultaneous split thickness skin graft take and induced functional neodermal tissue deposition. When compared to a market leading product Integra Bilayer Wound Matrix, which was used in a multistep procedure (STSG placed 14 days after product implantation according to the product IFU), DermiSphere induced a similar moderate and transient inflammatory response that produced similar neodermal tissue maturity, thickness and vascularity, despite being implanted in a single surgical procedure leading to wound closure 2 weeks earlier. These data suggest that DermiSphere may be implanted in a single-step procedure with an STSG, which would significantly shorten the time course required for the reconstruction of both dermal and epidermal components of skin after full thickness loss.

Reconstruction of penile skin loss by superficial circumflex iliac perforator (SCIP) pedicled flap after Fournier's gangrene

Fournier's gangrene is a serious pathology with a high mortality rate. Treatment requires a large debridement of necrotized tissues, conducing to a skin loss, requiring a reconstruction, which may involve different surgical techniques, depending on the context as well as the size and location of the skin loss. The most common covering technique uses split-thickness skin grafting, which however presents a risk of contracture. Our 63 years old patient presented a Fournier's gangrene, leading to pubic and circular penile skin defects after multiple debridements. We decided to practice a right superficial circumflex iliac perforator (SCIP) pedicled flap to reconstruct the penile skin sheath. The flap was rotated 180 degrees and rolled around the penis. The inguinal pedicle flap is described for penile reconstruction, the SCIP flap for perineal reconstruction, and even bilateral SCIP flaps for performing phalloplasty, but SCIP pedicled flap is not already described for isolated penile skin sheath reconstruction. Skin loss in our patient was not extensive, permitting us to perform this surgical technique. To go further, note the possibility of carrying out this reconstruction by a super-thin SCIP flap, as a pure skin graft flap. The SCIP pedicled flap seems us to be a safe technique for penile skin reconstruction and a good alternative to the usual skin grafts, especially regarding the lower risk of contracture, and low donor-site morbidity.

(226) SCLEROSING GRANULOMA AFTER PARAFFIN INJECTION FOR PENILE AUGMENTATION: A COMPARISON BETWEEN TWO SURGICAL TECHNIQUES

Abstract Objectives Our aim is to compare two different surgical techniques for the treatment of penile paraffinoma in order to identify the most suitable technique for the characteristics of each patient. Methods We described two different surgical techniques for the correction of penile paraffinoma performed in our Urological Unit. In this video we report two cases. The first patient was a 23 years-old Bulgarian male admitted to our hospital in 2020 with penile swelling and sexual discomfort due to paraffin injected 1 year before to increase penile girth. The patient underwent a 2-stages surgical technique: during the first stage the paraffinoma was excised. The penis was buried into the scrotum. Three months later a scrotoplasty was performed. The second patient a 40 years-old Serbian men presented to our hospital in 2019 with a severe penile deformity due to multiple paraffine self-injection resulting in pain and sexual discomfort. The patient underwent a paraffinoma excision and split-thickness skin graft in one stage. Two different questionnaires, the international index of erectile function (IIEF-5) and a 6-items questionnaire on the satisfaction of genital aesthetics, were delivered to the paients by email at 3, 6 and 12 months. Results Erectile dysfunction was not reported and the scores of the IIEF-5 were comparable during the follow up. Both patients were satisfied with the aesthetic of their genitalia, however the first patient scored better in the 6-items questionnaire. No intra/post-operative complications were observed in both techniques. Conclusions In our experience patients with no scrotal involvement and suitable scrotal size benefit a dual stage technique with scrotoplasty in terms of better aesthetic outcome rather than a split-thickness skin graft. Otherwise patients with small scrotum size or scrotal involvement might undergo split thickness skin graft which provides good aesthetic outcome and a comparable sexual function. From our experice the surgeon should be skilled in both technique and a careful evaluation of patient's charactheristics should suggest wich technique fits the patient. Conflicts of Interest The Authors declair no conflict of interest.

Auxetic incisions with alternating slit shapes: a promising technique for enhancing synthetic skin grafts expansion

Split thickness skin grafts are widely used in treating burn injuries. To date, with limited availability of donor skin and minimal expansions offered by conventional skin grafting, it is challenging to cover large and severe burns. In this study, novel synthetic skin grafts with alternating slit (AS) shaped cut patterns were developed and tested to evaluate the expansion potentials offered by auxetic or negative Poisson’s ratio structures in skin grafting. A range of auxetic incision patterns were designed with varying unit cell dimensions, and these were projected onto skin using 3D printing. The mechanical properties and digital image correlation of the created synthetic skin grafts were used to determine stress, effective Poisson’s ratio, meshing ratio (MR), and generated strains for strain loadings of up to 150%. The AS graft simulant with equal slit lengths and low slit spacings exhibited the maximum negative Poisson’s effect, expansion, and Mr Expansions were inversely related with the spacing between slits. The lowest value for the MR and highest stress was observed with high spacing, high horizontal slit length, and low vertical slit length. The expansions were highly sensitive to the applied strain, with low strains exhibiting high auxeticity. Such an extensive experimental investigation of the expansion potentials and stress estimations of skin grafts with varying AS dimensional parameters have not been conducted previously. The findings would be crucial for advancing research on mitigation of large burn injuries using high expansion skin grafts.

Single Stage Excision and Thick Split Thickness Skin Graft Technique for Facial Giant Congenital Melanocytic Nevi with Consideration of Facial Aesthetic Subunits: A Case Report and Literature Review

Due to their three-dimensional anatomy, functional importance, and esthetic appeal, giant congenital melanocytic nevus (GCMN) of the face pose the greatest challenge to reconstructive surgeons, especially when there are few donors and a significant deformity. A 25-year-old male patient presented with a facial GCMN. GCMN management involves complete nevus removal and reconstruction using tissues of the same color, thickness, and as the surrounding skin. Some defect closure options were inapplicable due to the almost complete forehead defect. This study aims to report the author's successful experience treating an adult case of GCMN with single-stage excision and subunit facial restoration using thick split-thickness skin graft (STSG). In this case, thick STSG is considered to prevent the risk of secondary contracture and conspicuous discoloration. In addition to esthetic and functional outcomes, the patient's social status and self-esteem also improved. This technique promises esthetic results, such as reduced downtime, and improved psychological function.

Reconstruction with an Anterolateral Thigh Free Flap Following a Skin Graft from the Same Donor Site for Tissue Use Efficacy: Two Case Reports

The coverage of extensive soft tissue defects requires several considerations, such as limited donor sites, reconstruction methods, and the outcome of functional recovery. In the cases described herein, when a significant soft tissue defect was present on an extremity, we opted for staged reconstruction. We first performed a split-thickness skin graft (STSG) to reduce the soft tissue defect, using the anterolateral thigh (ALT) as the donor site. In the second stage, the remaining soft tissue defect was reconstructed with an ALT free flap, utilizing the same lateral thigh area that had previously served as the STSG donor site. After the free flap procedure, we encountered several challenges in monitoring the ALT flap; however, all flaps ultimately survived. To the best of our knowledge, this is the first report of using an ALT free flap following STSG from the same donor site, demonstrating efficient tissue utilization. We believe this approach is beneficial for reconstructing extensive soft tissue defects, as it maximizes tissue use efficiency and reduces donor site morbidity when donor options are limited.

Inflammatory myofibroblastic tumor of right leg and calcified fibroadenoma of left breast removed from a postmenopausal-women: a rare case report and review of literature

Inflammatory myofibroblastic tumors are uncommon neoplasms; presentation of these tumors in the lower extremities is extremely rare. Treatment varies depending on type, location and patient factor. Here the case of 60-year-old female post-menopausal (P2L2) presented with swelling over anterior aspect of right leg which was exophytic in nature and left breast lump. Combined histopathology and immunohistochemistry findings favoured myofibroblastic tumor of borderline category- inflammatory myofibroblastic tumor. Mammography of left breast showed presence of fibroadenoma at 12 o’ clock position. Patient underwent wide local excision of right leg swelling followed by split thickness skin grafting and excision of left breast swelling (lumpectomy). Inflammatory myofibroblastic tumors are of varied biologic potentials. They are generally classified as tumours of intermediate biological activity with uncertain malignant potential. There are many factors which affect treatment and prognosis of the patient. Five types of standard treatment for sarcoma are used: surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy. Fibroadenomas are benign breast neoplasms, typically present in women from ages of 20-35 years old (premenopausal).

DS25 Postsurgical pyoderma gangrenosum successfully managed with skin grafting in a breastfeeding postpartum patient

Abstract A 32-year-old woman who was breastfeeding presented 7 weeks postpartum with right breast pain, swelling and erythema. A clinical diagnosis of mastitis was confirmed on ultrasound, and she was started on intravenous (IV) flucloxacillin. Initial cultures grew methicillin-sensitive Staphylococcus aureus, and clindamycin was added. She failed to improve and 6 days later an abscess was incised and drained. A vacuum-assisted closure (VAC) dressing was placed over the wound postoperatively. Over the following 3 days, she deteriorated clinically with markedly increased pain, spiking temperatures and malaise. Linezolid and metronidazole were added. On return to theatre for wound review, she had an 18 cm × 10 cm deep necrotic ulcer with purulent discharge, sparing the nipple. The breast surgeon’s concern was that of necrotizing fasciitis, and an immediate wider debridement was performed, removing all breast skin except for the nipple. Dermatology was then consulted, and a diagnosis of pyoderma gangrenosum (PG) was made. The patient was commenced on IV methylprednisolone 1 g daily for 3 days. Her temperature normalized immediately, and her C-reactive protein dropped from 141 to 27 mg L−1 in 24 h. The previously rolled, violaceous wound edges settled with no further progression. Following 3 days of steroid, ciclosporin 5 mg kg−1 daily was commenced. The right breast continued to lactate, and the very large defect now present was anticipated to pose many difficulties for the young mother. Five weeks after the initial presentation, and following multidisciplinary discussion, a biodegradable temporizing matrix (BTM; NovoSorb®) was applied, under continued dermatologist-supervised immunosuppression. The BTM took with good effect. Two weeks later, a split-thickness skin graft was applied to the BTM. The skin grafting took successfully, with no reactivation of PG postoperatively. Three months postgrafting, the patient is now being weaned off ciclosporin and remains well. Postpartum PG is rare and is predominantly reported at the site of caesarean section incision. Surgery is typically discouraged in PG owing to the risk of disease reactivation. However, surgery in this case was considered appropriate due to the rapid disease control with immunosuppression, the extent of ulceration, the expected prolonged healing period requiring exposure to the toxicity of ciclosporin and the avoidance of cribriform scarring often seen with PG. This case highlights how PG should always be considered in postpartum patients presenting with rapidly progressing, nonhealing ulcers. It also shows that, despite our usual treatment practices, in certain cases, early surgical intervention can be considered alongside ongoing immunosuppression resulting in positive patient outcomes.

Reconstructing complex peripatellar defects using the descending genicular artery perforator flap.

Complex peripatellar defects are commonly reconstructed with free flaps or pedicled muscle flaps, whereas pedicled fasciocutaneous perforator flaps are commonly overlooked. The descending genicular artery perforator (DGAP) flap is a versatile flap that offers thin and pliable tissue that provides ideal 'like with like' peripatellar soft tissue defect reconstruction. This paper aims to demonstrate the safe use of a pedicled fasciocutaneous DGAP flap for extensive traumatic peripatellar defect reconstructions and to exhibit the surgical pearls via a case series. A retrospective cohort study of consecutive complex peripatellar reconstructions with DGAP flaps was conducted from January 2011 to December 2018. Patient demographics, medical comorbidities, aetiology/size/and location of the defects were reviewed. Flap, donor site, and overall surgical outcomes were clinically assessed and documented. Descriptive statistics were conducted and analysed by IBM SPSS Statistics 23. Five consecutive cases with complex peripatellar defects (5 × 8 to 8 × 10 cm) were recruited. Two were males, and three were females, with a mean age of 38.4 years. Four were trauma, and one was an oncological case. Descending genicular artery (DGA) perforators and DGA terminal branches were consistent. One patient needed a split-thickness skin graft to reconstruct the secondary defects. All the flaps survived with an average follow-up of 24 months. The DGAP flap provides a reliable alternative to free flap for the large, complex peripatellar defect. With the inclusion of the proximal long saphenous vein and judicious selection of DGA perforators and its terminal branches, the DGAP flap can be harvested and used safely in the high-velocity impacted knee.

Vestibuloplasty and its impact on the long-term survival and success of dental implants in irradiated and non-irradiated patients after head and neck tumor therapy: a retrospective study

ObjectivesThis study aimed to evaluate the influence of vestibuloplasty on the clinical success and survival of dental implants in head and neck tumor patients.Materials and methodsA retrospective single-center study was conducted. All patients received surgical therapy of a tumor in the head or neck and underwent surgical therapy and, if necessary, radiotherapy/radiochemotherapy. Patients with compromised soft tissue conditions received vestibuloplasty using a split thickness skin graft and an implant-retained splint. Implant survival and success and the influence of vestibuloplasty, gender, radiotherapy, and localizations were evaluated.ResultsA total of 247 dental implants in 49 patients (18 women and 31 men; mean age of 63.6 years) were evaluated. During the observation period, 6 implants were lost. The cumulative survival rate was 99.1% after 1 year and 3 years and 93.1% after 5 years for patients without vestibuloplasty, compared to a survival and success rate of 100% after 5 years in patients with vestibuloplasty. Additionally, patients with vestibuloplasty showed significantly lower peri-implant bone resorption rates after 5 years (mesial: p = 0.003; distal: p = 0.001).ConclusionThis study demonstrates a high cumulative survival and success rate of dental implants after 5 years in head and neck tumor patients, irrespective of irradiation. Patients with vestibuloplasty showed a significantly higher rate of implant survival and significantly lower peri-implant bone resorption after 5 years.Clinical relevanceVestibuloplasty should always be considered and applied if required by the anatomical situations to achieve high implant survival/success rates in head and neck tumor patients.

Autologous Skin Grafts, versus Tissue-engineered Skin Constructs: A Systematic Review and Meta-analysis.

A systematic review was conducted using PRISMA guidelines, querying MEDLINE, Embase, Web of Science, and Cochrane to assess graft incorporation, failure, and wound healing. Case reports/series, reviews, in vitro/in vivo work, non-English articles or articles without full text were excluded. Sixty-six articles encompassing 4076 patients were included. No significant differences were found between graft failure rates (P = 0.07) and mean difference of percent reepithelialization (p = 0.92) when split-thickness skin grafts were applied alone versus co-grafted with acellular TCs. Similar mean Vancouver Scar Scale was found for these two groups (p = 0.09). Twenty-one studies used at least one cellular TC. Weighted averages from pooled results did not reveal statistically significant differences in mean reepithelialization or failure rates for epidermal cellular TCs compared with split-thickness skin grafts (p = 0.55). This systematic review is the first to illustrate comparable functional and wound healing outcomes between split-thickness skin grafts alone and those co-grafted with acellular TCs. The use of cellular TCs seems promising from preliminary findings. However, these results are limited in clinical applicability due to the heterogeneity of study data, and further level 1 evidence is required to determine the safety and efficacy of these constructs.

Comparison of Uncultured Cell Spray and Split-Thickness Skin Grafting in Deep Partial-thickness Burns: A Novel Animal Model.

To compare uncultured cell spray and conventional surgery in deep second-degree burns in rats and create an experimental model for the use of this method. An experimental study. Place and Duration of the Study: Hacettepe University Experimental Animals Application and Research Center, Ankara, Turkey, from October 2018 to December 2020. Twenty-four Wistar albino rats were divided into 4 groups. Two deep second-degree burns were created on the dorsal skin in different locations. On the 5th day of the burn wound, a split-thickness skin graft was applied to one of the burn wounds with half of the donor graft. Two-stage enzyme application was performed on the other half of the donor graft and keratinocytes were applied as a spray to the other tangential excision burn wound. Samples taken by excisional biopsy on certain days were examined macroscopically and histologically. In all the experimental groups according to sacrification days, macroscopic healing percentages, non-epithelised areas, inflammation and neovascularisation scoring were similar between graft side and spray side. The effects of conventional split-thickness skin graft and uncultured cell spray on wound healing were comparable, suggesting that the uncultured cell spray method can be used as an alternative method to the classical burn treatment. Deep second-degree burn, Grafting, autologous cell, Non-cultured cell spray, Keratinocyte.

A NOVEL TECHNIQUE FOR MANAGEMENT OF A CRITICALLY-SIZED BONE DEFECT IN THE OPEN PROXIMAL TIBIAL FRACTURE: EMPLOYING THE CAPANNA TECHNIQUE IN TRAUMA

A NOVEL TECHNIQUE FOR MANAGEMENT OF A CRITICALLY-SIZED BONE DEFECT IN THE OPEN PROXIMAL TIBIAL FRACTURE: EMPLOYING THE CAPANNA TECHNIQUE IN TRAUMA

Malignant Phyllodes Tumor in the Male: A Case Report

Phyllodes tumors are breast tumors accounting for about 1% of all breast neoplasms in women and are rare in males. Reported here is a case of a 45-year-old male presenting with a rapidly enlarging right breast mass with invasion of the anterior chest wall. Core Needle Biopsy revealed Malignant Phyllodes Tumor. He underwent wide excision and chest wall resection. Reconstruction was performed using polyropelene mesh, a latissimus dorsi flap and split thickness skin grafting. Patient was discharged on the 33rd post-operative day due to delayed expansion of the right lung from splinting and subsequent near-complete loss of the split thickness skin graft over the latissimus muscle flap. On the recommendation of the plastic surgeon, the wound was allowed to heal by secondary intention. This report draws attention to the rarity of malignant phyllodes tumor in males, and the difficulty of recognizing a malignant pathology in males presenting with breast mass. It also highlights a cost-effective treatment option in the management of these tumors. Key words: Malignant Phyllodes tumor, Male Phyllodes tumor, breast

Comparison of Uncultured Cell Spray and Split-Thickness Skin Grafting in Deep Partial-thickness Burns: A Novel Animal Model

Comparison of Uncultured Cell Spray and Split-Thickness Skin Grafting in Deep Partial-thickness Burns: A Novel Animal Model

Management of floating arm: a case report.

This study report a 59-year-old man with a rare humeral fracture and a severe crush injury of the forearm. There is a paucity of evidence regarding the management of concomitant floating arm and soft tissue injuries in the literature.The patient was managed by minimally invasive plate osteosynthesis (MIPO) and vacuum-assisted closure (VAC) followed by a split-thickness skin graft. The concurrent presence of the two pathologies exacerbated the patient's condition and made the management challenging. In this case, the authors have used the MIPO approach to fix both fractures with minimal soft tissue injury. To manage the prominent soft tissue injury, we applied the VAC device. VAC has the advantages of reducing edema, controlling bacterial growth, and promoting granulation tissue formation, leading to faster cellular turnover and healing. In patients with floating arm, especially with concomitant soft tissue damage, the MIPO approach is a safe, minimally invasive, and quick method with minimal bleeding.

Beauty Borne out of Chaos: Molding a Surgical Subspecialty Through the World Wars.

The chaos during the Great Wars provided the impetus for the genesis of modern plastic surgery. Collectively, the World Wars caused disfiguring injuries to thousands of American soldiers, which challenged their acceptance into society. The Wars, however, propelled 2 leaders in the field of plastic surgery-Vilray P. Blair and James Barrett Brown. These two American pioneers used their surgical acumen and artistic skills to heal the wounds of the soldiers. During World War I, the wounds of injured soldiers were often poorly managed by inadequately trained surgeons and dentists. Upon return to the United States, these soldiers underwent specialized treatment under Blair's supervision. During World War II, James Barrett Brown, a disciple of Blair, was appointed as a consultant in the war. He spearheaded the establishment of several plastic surgery centers in Europe. Upon his return from the War, he led the plastic surgery service at Valley Forge General Hospital in Phoenixville, PA, where thousands of soldiers were sent after their initial operations in the war zones. Care of war wounds served as an impetus for the development of new techniques in reconstructive and plastic surgery. These techniques included a delayed transfer of long pedicled flaps and split-thickness skin grafts. Through our archival research at the Bernard Becker Medical Library at Washington University in St. Louis, we provide evidence for how reconstructive surgical approaches were advanced during the Great Wars and helped restore some form of normalcy to the lives of the injured soldiers.