Split-thickness Skin Graft Research Articles

Efficacy of a Novel LAM Femoral Cutaneous Block Technique for Acute Donor Site Pain.

Patients with severe burn injuries often require split-thickness skin grafting to expedite wound healing with the thigh being a common donor site. Uncontrolled pain is associated with increased opioid consumption, longer lengths of stay, and delay in functional recovery. Peripheral nerve blocks are increasing in popularity although supportive literature is limited, and techniques vary. The purpose of this case series is to assess the safety, feasibility, and clinical efficacy of a recently demonstrated novel continuous LAM (lateral, anterior, medial) femoral cutaneous block technique in a larger cohort. The study was a dual IRB approved, observational case series from a single verified burn center. The electronic health record was retrospectively reviewed for patients admitted between June 2018 and May 2021 who had the continuous LAM block performed for donor site pain by the acute pain service team. Demographics were reported with descriptive statistics and morphine milligram equivalents (MME) were analyzed via Friedman analysis of variance. Forty-seven patients had a total of 53 blocks placed, where 2 patients received the LAM block on two separate occasions and 4 patients had bilateral LAM blocks placed. Most were African-American males, but mechanism of injury varied. Over half had a neurologic (17%) or psychiatric history (34%) outside of substance use. Almost three-quarters had a history of substance use with 17% being opioids, and a quarter had a history of polysubstance use. Median day from admission to LAM was 7 (2.5, 11.5) with a median duration of 4 (3, 5) days. Temperature and pressure sensation were reduced at the donor site. Quadricep strength remained intact, and median day until first ambulation after LAM placement was 2 (1, 3) days. Pain was adequately controlled, and there were no significant adverse events associated with the block. There was a significant reduction in MME after block placement (p < .001). Continuous peripheral nerve blocks offer an advantageous means of analgesia, while reducing potential adverse events associated with opioids or multimodal regimens. The novel LAM technique reduced sensation and pain without inhibiting early ambulation, and patients were able to fully participate in their rehabilitation.

Evaluating Adverse Outcomes in Anticoagulated Patients Undergoing Skin Grafting for Diabetic Foot Ulcers

INTRODUCTION: Split thickness skin grafting (STSG) is a common method for wound closure in patients with diabetic foot ulcers (DFUs). Many diabetic patients have co-morbidities necessitating long-term anticoagulant therapy. These medications may cause surgeons to avoid STSG, but our experience does not warrant such concerns. No published studies examine the risks of skin grafting in the setting of chronic anticoagulation. We posit that anticoagulant therapy has no effect on STSG failure or other adverse outcomes. METHODS: We queried the TriNetX Network, which provides access to electronic medical records for over 75 million patients from 57 healthcare organizations throughout the U.S., for patients with a history of DFUs treated with STSG. We divided those found into two groups: long-term anticoagulant use prior to grafting and no long-term anticoagulant use. Patients were propensity score matched by age and comorbidities. Outcomes following STSG were evaluated at 1 month and 5 years. RESULTS: After matching, we found 429 patients for the matched cohorts. Within 1 month, the anticoagulated group showed no significant increase in graft failure (p = 0.825) or regrafting (p = 0.1243). For long-term outcomes, we found no significant increase in graft failure (p = 0.2797) or regrafting (p = 0.3524) (Figure 1). However, the anticoagulated group had a significant increase in endovascular procedures (p = 0.0096) and amputation (p = 0.0117), and a trend toward death (p = 0.066). CONCLUSION: Anticoagulation therapy does not lead to increased complications after STSG for wound closure, though remain at risk for other complications. All those with diabetic foot ulcers should receive standard of care treatment including STSG when appropriate.

Upper Limb Salvage Surgery Due to Explosion Using Vacuum-Assisted Closure: A Case Report

High trauma injuries of the forearm frequently present with complex bone and soft tissue defects. Early repair is required to retrieve the extremity and restore its function, As the advance of surgical repair and reconstruction technology, limbs damaged by high energy trauma that might have needed to be amputated in the past can now be saved by surgical reconstruction&#x0D; This is a case report of 36 year old man with left upper limb injury after high energy explosion trauma where a large soft tissue defect of the forearm with exposure of the vital structures and fracture of the ulna and radius and the fracture of radius and ulna were fixed by Elastic Nail to maintain their alignments and length, and put a cerclage on the fracture site of the radius to hold a fragment. The large soft tissue was reconstructed by a primary tendon and muscle repair, with vacuum assisted closure followed by split thickness skin graft. And at 6 Weaks physıotherapy was started wıth dynamıc hand splınt by slıgthly flexıng the fıngers&#x0D; The application of VAC as temporary coverage of large tissue defects in upper limbs supports wound conditioning and facilitates the definitive wound closure.

Application of collagen-chondroitin sulfate scaffolds with different pore sizes combined with acidic fibroblast growth factor in repairing full thickness skin defects in nude mice

Wound healing of skin defects is complex. For the treatment of large and deep wounds, it is a good alternative to accept artificial dermis grafting at the first stage surgery, and autologous split-thickness skin grafting 2–3 weeks later at the second stage surgery. In addition, the effectiveness of numerous cytokines such as fibroblast growth factor (FGF) on wounds healing has been widely researched. The traditional view is that direct external application or in vivo injection of exogenous FGFs may not achieve the desired therapeutic effect as the effective concentration cannot be maintained for a long time. Therefore, some researchers have tried to integrate various cytokines into skin substitutes for combined application. However, we believe that considering the current situation, it is still difficult to achieve mass production of these types of artificial dermis. Here, we manufactured a collagen-chondroitin sulfate scaffold material by imitating the marketed artificial dermis materials. Then, we combined it with recombinant human acidic FGF in a single full dose during the first-stage artificial dermis transplantation, which is simple and completely feasible but always controversial in the current clinical work, to explore whether this combinatorial therapy could serve as an efficient way wound healing in the Balb/c-nu mice full-thickness skin defect model.

Comparative study between split thickness skin graft and split thickness dermal graft in coverage of raw areas

Comparative study between split thickness skin graft and split thickness dermal graft in coverage of raw areas

Role of split thickness skin grafting in post burn contracture neck

Optimizing functional and aesthetic outcomes in post burn head and neck reconstruction remains a surgical challenge. Recurrent contractures, impaired range of motion, and disfigurement because of disruption of the aesthetic subunits of the face, can result in poor patient satisfaction and ultimately, contribute to social isolation of the patient. Despite advancements in post burn head and neck reconstruction, such as the advent of free-tissue transfer, split thickness skin graft remains the mainstay of cover in most burn care institutions around the world. Usually skin graft is required to cover raw area after release of contracture. But in case contracture is associated with non-healing ulcer which may become source of infection then skin grafting for non-healing ulcer should be done before release of contracture. In this study we are sharing our experience of post burn neck contracture associated with non-healing ulcer in which first skin grafting was done for ulcer &amp; then release of contracture &amp; skin grafting was done.

The Use of Matriderm® for Scalp Full-Thickness Defects Reconstruction: A Case Series.

Background: The scalp region represent a common area affected by benignant and malignant skin tumor, and it represents a surgical challenge when it is needed to be reconstructed. The aim of this study is to present our experience with full-thickness scalp skin defects, reconstructed using Matriderm® dermal substitute and split-thickness skin graft (STSG). Methods: A retrospective analysis of patients treated for scalp region reconstruction was conducted with 16 patients. All patients underwent the same procedure: scalp full-thickness tumor excision with simultaneous reconstruction with Matriderm® and the application of a split-thickness skin graft in the same surgical time. During follow-ups, the surgical outcome was evaluated by accurate clinical examination of the wound, adopting the Vancouver Scar Scale (VSS). Results: The outcomes obtained were satisfying: wound healing at the end of the procedures was optimal, grafted skin resulted similar to surrounding tissue, and pigmentation and vascularity showed a decrease in the period between 6 months and 1 follow-up. Conclusions: The use of Matriderm® and split-thickness skin grafting for scalp full-thickness defects reconstruction resulted in an optimal, stable, and safe procedure, suitable for elderly patients.

V-041 ENTEROCUTANEOUS FISTULA TAKEDOWN AND VENTRAL HERNIA REPAIR WITH PREPERITONEAL MESH

Abstract In this video, we present a 48-year-old otherwise healthy man with a history of perforated appendicitis status post exploratory laparotomy and appendectomy, complicated by an intraabdominal abscess requiring re-exploration and subsequent midline wound dehiscence, incisional ventral hernia, and enterocutaneous fistula managed with a drain. Plastic surgery performed a split thickness skin graft of his midline wound, and his drain was kept in place until surgery. The patient was taken to the operating room for a takedown of his enterocutaneous fistula and an open repair of his incisional ventral hernia. We entered the abdomen in the midline, far away from the fistula. After lysing omental and bowel adhesions, we identified the patient's drain entering the small bowel and exiting about 10 cm distally. We removed the drain from the small bowel and performed a small bowel resection, including the entry and exit points of the drain, and a stapled side-to-side antiperistaltic anastomosis. Preperitoneal planes were developed bilaterally, and the peritoneum was rearranged over the bowel and partially closed to the omentum. We placed a biologic mesh into the preperitoneal plane and secured it in place with transfascial sutures. We then performed a multilayer closure of the fascia and dermis and an incisional negative pressure dressing was placed over the wound. The patient was discharged on postoperative day 4 after tolerating a regular diet and having full return of bowel function. In summary, this video demonstrates several important operative techniques in our approach to this complex case.

Efficacy of split-thickness skin graft combined with novel sheet-type reprocessed micronized acellular dermal matrix

BackgroundAutologous split-thickness skin grafts (STSGs) remain the mainstay for treatment of large skin defects. Despite its many advantages, there exist critical disadvantages such as unfavorable scar and graft contracture. In addition, it cannot be used when structures such as tendons and bones are exposed. To overcome these limitations, acellular dermal matrix (ADM) is widely used with STSG. CGDerm Matrix®, which was recently developed, is a novel reprocessed micronized ADM (RMADM). In this study, outcomes of the combined application of RMADM and STSG on full-thickness wounds were analyzed.MethodsForty-one patients with full-thickness skin defects due to trauma, scar contracture release, and diabetic foot ulcers, who underwent STSGs, from January 2021 to July 2021, were retrospectively reviewed. The primary outcome of interest was skin loss rate, which was measured 14 days after surgery.ResultsThe most common cause of skin defect was trauma (36 patients), diabetic foot (2 patients), scar contracture release (2 patients), and malignancy (1 patient). The average defect size was 109.6 cm2 (range, 8–450 cm2). The average skin loss rate was 9.1%, showing a graft take rate of > 90%.ConclusionThe use of combined RMADM and STSG in full-thickness wound reconstruction provides stable and acceptable outcomes. The newly developed ADM can be a promising option in wound reconstruction.

Accelerated vascularization of a novel collagen hydrogel dermal template.

Full thickness skin loss is a debilitating problem, most commonly reconstructed using split thickness skin grafts (STSG), which do not reconstitute normal skin thickness and often result in suboptimal functional and esthetic outcomes that diminish a patient's quality of life. To address the minimal dermis present in most STSG, engineered dermal templates were developed that can induce tissue ingrowth and the formation of neodermal tissue. However, clinically available dermal templates have many shortcomings including a relatively slow rate and degree of neovascularization (∼2-4weeks), resulting in multiple dressing changes, prolonged immobilization, and susceptibility to infection. Presented herein is a novel composite hydrogel scaffold that optimizes a unique scaffold microarchitecture with native hydrogel properties and mechanical cues ideal for promoting neovascularization, tissue regeneration, and wound healing. In vitro analysis demonstrated the unique combination of improved mechanical attributes with native hydrogel properties that promotes cell invasion and remodeling within the scaffold. In a novel 2-stage rat model of full thickness skin loss that closely mimics clinical practice, the composite hydrogel induced rapid cell infiltration and neovascularization, creating a healthy neodermis after only 1week onto which a skin graft could be placed. The scaffold also elicited a gradual and favorable immune response, resulting in more efficient integration into the host. We have developed a dermal scaffold that utilizes simple but unique collagen hydrogel architectural cues that rapidly induces the formation of stable, functional neodermal tissue, which holds tremendous promise for the treatment of full thickness skin loss.

Platelet-derived concentrates influence human keratinocyte proliferation in vitro and induce wound healing in a prospective case series of chronic wounds of different entities in vivo.

ObjectivesSoft tissues defects can extend into the fat layer or even deeper and can cause significant clinical disadvantages like pain, infections, and loss of function. In particular, chronic wounds are difficult to treat, as split-thickness skin grafts (STSGs) have varying success rates. To improve wound healing in chronic wounds, the authors have studied the application of platelet-mediator concentrate (PMC) in a human keratinocyte culture model in vitro and of autologous platelet concentrates (PRP) in a combination with surgical procedures in vivo as second line therapy in patients with initially failed wound closure.MethodsFor in vitro testing on keratinocytes, a PMC was processed with a commercially available bedside system (ATR®, Curasan, Germany). In a clinical, nonrandomized study, five in-house patients with chronic wounds were treated using a combination of surgical debridement and autologous PRP. Time of healing as determined by epithelization as well as laser Doppler imaging to visualize blood flow was analyzed. Additionally, changes in ease of surgical wound closure were determined. Finally, the quality of life of patients was assessed using a validated questionnaire (clinicaltrials.gov # NCT03667638).ResultsIn vitro testing shows a significant effect of PMC on keratinocyte proliferation in cell culture. Clinical studies showed that patients treated with PRP had initiation of wound closure, higher blood flow after PRP injection, and easier wound closure as well as improved quality of life.ConclusionsThe injection of platelet concentrates to treat chronic wound defects presents a favorable addition to treatment where single surgical procedures have failed and may improve current therapy options.

Comparison of Glyaderm with different dermal substitute matrices in a porcine wound model

BackgroundThe closure of extensive burn wounds with widely expanded autologous split-thickness skin grafts (STSG) is associated with undesirable scar formation and contraction, due to the lack of dermis. Various materials for dermal replacement have been developed, either of xenogeneic, allogeneic or synthetic origin and are placed in the wound underneath a thin STSG in order to improve scar quality. In this study, a porcine wound model was used to compare several commercially available acellular dermal substitutes with an acellular dermal substitute prepared from glycerol preserved human skin: GlyadermⓇ. MethodsAntigenic components of the allografts were removed by incubation in the 0.06 M NaOH solution. In the first experiments, the dermal substitutes were applied to full thickness wounds and covered simultaneously with STSG. Controls were covered with STSG only. The wound healing response was analyzed for 8 weeks, both macroscopically and histologically. The Mann-Whitney U test was used for statistical analysis. In the second series of experiments, GlyadermⓇ was applied in a two-stage procedure in comparison to Integra. The STSG was placed on the dermal substitutes one week later. ResultsIn the first series, the inflammatory response and myofibroblast influx in GlyadermⓇ were limited, indicating possible beneficial outcomes on final wound healing results. The survival of the STSG on the acellular dermis was lower compared to the control wounds. Second series: the take of the STSG was the same as in the controls, but additionally wound contraction was reduced. The application of GlyadermⓇ was non-inferior to Integra. ConclusionGlyadermⓇ can be successfully used for the reduction of wound contraction when applied in a two-stage procedure.

Buried Penis Reconstruction in the Management of Localized Penile Cancer

The objective of this article is to describe surgical techniques for the management of localized penile cancer concurrent with adult acquired buried penis. Penile cancer, while rare, invariably impacts quality of life as the primary surgical management ranges from local excision to total penectomy. Penile cancer has recently been linked to adult acquired buried penis (AABP) with the hypothesis that chronic inflammation of the penis contributes to risk of penile malignancy. Buried penis reconstruction is now a well-described procedure involving escutcheonectomy and split thickness skin grafting which has been shown to improve quality of life in individuals with adult acquired buried penis. This report describes a patient with AABP requiring partial penectomy and inguinal node dissection who also underwent adult acquired buried penis repair during his procedure. A review of cases of buried penis cases was carried out and four other cases of penile cancer were identified who were managed with penile preserving procedures. This combination of surgical techniques strives to improve quality of life and facilitate cancer surveillance without compromising oncologic outcomes.

Management of wounds with exposed bone structures using an induced-membrane followed by polymethyl methacrylate and second-stage skin grafting in the elderly with a 3-year follow-up.

The treatment of traumatic wounds with exposed bone or tendons is often challenging. An induced membrane (IM) is used to reconstruct bone defects, as it provides an effective and sufficient blood supply for bone and soft-tissue reconstruction. This study explored a novel two-stage strategy for wound management, consisting of initial wound coverage with polymethyl methacrylate (PMMA) and an autologous split-thickness skin graft under the IM. Fifty inpatients were enrolled from December 2016 to December 2019. Each patient underwent reconstruction according to a two-stage process. In the first stage, the defect area was thoroughly debrided, and the freshly treated wound was then covered using PMMA cement. After 4-6 weeks, during the second stage, the PMMA cement was removed to reveal an IM covering the exposed bone and tendon. An autologous split-thickness skin graft was then performed. Haematoxylin and eosin (H&E) staining and immunohistochemical analysis of vascular endothelial growth factor (VEGF), CD31 and CD34 were used to evaluate the IM and compare it with the normal periosteal membrane (PM). The psychological status and the Lower Extremity Function Scale (LEFS) as well as any complications were recorded at follow-up. We found that all skin grafts survived and evidenced no necrosis or infection. H&E staining revealed vascularised tissue in the IM, and immunohistochemistry showed a larger number of VEGF-, CD31- and CD34-positive cells in the IM than in the normal PM. The duration of healing in the group was 5.40 ± 1.32 months with a mean number of debridement procedures of 1.92 ± 0.60. There were two patients with reulceration in the group. The self-rating anxiety scale scores ranged from 35 to 60 (mean 48.02 ± 8.12). Postoperatively, the LEFS score was 50.10 ± 9.77. Finally, our strategy for the management of a non-healing wound in the lower extremities, consisting of an IM in combination with skin grafting, was effective, especially in cases in which bony structures were exposed in the elderly. The morbidity rate was low.

Micronized dermal grafts (Rigenera™) and split-thickness skin grafts alone or in combination for deep dermal burn wounds

IntroductionFull-thickness skin damage due to deep dermal burn (DDB) and deep burn (DB) often requires skin grafting. Adverse effects of these grafts include unsightly scars and scar contracture, leading to functional limitations and cosmetic appearance issues. Micronized dermal grafts have been reported to improve not only wound healing, but also the cosmetic appearance of scars, which is consistent with the treatment goals of DDB. Our study presents observations on the effectiveness of treating DDB and DB using a micronized dermal graft alone or in combination with a split-thickness skin graft (STSG). Patients and methodsThis is a retrospective case series of six patients with DDB or DB; three were treated either with micronized dermal graft alone (16 to 21 days after injury) and three were treated in combination with meshed STSG at a ratio of 1:3 (7 to 22 days after injury). Autologous micrografts for grafting were obtained using Rigenera™ technology. Clinical observations of the wounds until complete epithelization was done, noting incidence of hypertrophic scars and viscoelasticity based on the Vancouver Scar Scale (VSS). Histopathological examination including hematoxylin and eosin stain, Elastica van Gieson stain, immunohistochemistry, and transmission electron microscopy was performed on the specimens of one patient with a large burn area treated half by STSG alone and half by STSG with a micronized dermal graft. ResultsComplete epithelization was observed 34.5 ± 6.7 days after sustaining injury and 18.2 ± 7.6 days from the micronized dermal graft treatment across all six patients. The mean total VSS score was 2.5 ± 1.9 at 7.5 ± 5.3 months after the procedure. No differences were noted between the micronized dermal graft alone and combination with STSG groups. For the patient treated with STSG or combination of STSG with micronized dermal graft, the combinatorial treated skin area showed a less obvious mesh pattern. Tissue imaging revealed mature fibroblasts with ordered collagen fibers, anchoring fibrils, and no abnormalities in the basal lamina for the combinatorial treatment. ConclusionMicronized dermal grafts show promise as an effective treatment for burn wounds with or without STSG.

P17 - Functional outcomes of glansectomy and reconstruction with split-thickness skin graft

P17 - Functional outcomes of glansectomy and reconstruction with split-thickness skin graft

Impact of Local Insulin Injection on Split Thickness Skin Graft Donor Site Healing

Impact of Local Insulin Injection on Split Thickness Skin Graft Donor Site Healing

SC210 - The outcomes of glansectomy and split thickness skin graft reconstruction for invasive penile cancer confined to glans

SC210 - The outcomes of glansectomy and split thickness skin graft reconstruction for invasive penile cancer confined to glans

Full thickness skin graft versus split thickness skin graft in paediatric patients with hand burns: Systematic review and meta-analysis

Our objective was to compare the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. A systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, and an electronic search was conducted to identify all Randomised Controlled Trials and non-randomised studies comparing the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. Primary outcomes included development of post-graft contracture and the necessity for surgical release. Secondary outcomes consisted of evaluation of function, cosmesis and colour, scar and feeling, hair growth, and other complaints. For the analysis, fixed effects modelling was applied. Results: ten non-randomised trials with a total of 532 grafts were found. Full thickness skin grafts exhibited a statistically significant decrease in the development of post-graft contracture (Odds Ratio [OR] = 0.35, P = 0.0001) and later surgical releases (OR = 0.06, P = 0.00001). For secondary outcomes, full thickness skin grafts outperformed split thickness skin grafts in post-operative functional ability. However, split thickness skin grafts, showed to be superior in scar, aesthetic, and colour assessments, and less hair growth was observed for split thickness skin grafts. No significant difference was seen in sensation and donor or recipient site complaints. Overall, full thickness skin grafts are a better alternative for paediatric hand burns than split thickness skin transplants because they are linked with reduced post-graft contracture and the requirement for surgical release.

Comparison of skin graft donor site management using oxidised regenerated cellulose (ORC)/collagen/silver-ORC with absorptive silicone adhesive border and transparent film dressing vs semi-occlusive dressings.

Split-thickness skin grafts (STSG) are widely used in wound reconstruction. However, donor site wounds are created as a result. Traditionally, moist wound healing and transparent film dressings have been used to promote donor site wound healing. This retrospective study evaluated the use of oxidised regenerated cellulose (ORC)/collagen/silver-ORC dressing (ORC/C/Ag-ORC) with an absorptive silicone adhesive border dressing and transparent film dressing (treatment) compared with petrolatum-based gauze dressing (control) over donor site wounds. Patients underwent an STSG procedure between January and December 2020. Donor sites received treatment (n=10) or control (n=10) dressings. Dressing changes occurred as necessary. Time to epithelialisation, narcotic pain medication requirements, and the number of office/hospital visits were examined. Twenty patients were managed (9 males, 11 females, average age: 49.7± 13.9y). Patient comorbidities included hypertension, diabetes, and hyperlipidemia. Wound types included traumatic and cancer excision. Time to epithelialisation was significantly reduced in the treatment group (11.1± 1.4d vs 18 ± 2.4d, P< 0.0001). The number of office visits for dressing changes was significantly lower in the treatment group (0.1± 0.3 vs 2± 0.7, P< 0.0001). No patients in the treatment group required a hospital visit, compared with 3 patients in the control group. One patient in the treatment group required narcotic pain medication, compared with 5 in the control group. In this patient population, the use of ORC/C/Ag-ORC, an absorptive silicone adhesive border dressing, and transparent film dressing resulted in a shorter time to epithelialisation and less analgesic requirement compared with petrolatum-based gauze dressing use.