Split-thickness Skin Graft Research Articles

Initial experience with ovine forestomach matrix graft for glossectomy defect reconstruction: A case series

Soft tissue reconstruction of oral cavity defects, such as glossectomy defects secondary to malignancy, pose a challenge for head and neck, oral, and maxillofacial surgeons. Reconstruction options for mucosal defects include primary closure, healing by secondary intention, full mucosal and split-thickness skin grafts, pedicled flaps, and microvascular free flaps. Biological grafts have become an integral part of the modern reconstructive ladder and are widely used for the regeneration of various soft tissue defects, including oral defects. This case series describes our initial experience using ovine forestomach matrix grafts in tongue and oral cavity reconstruction. Oral reconstruction using ovine forestomach matrix grafts was undertaken on three patients post wide excision and resulted in good functional and cosmetic outcomes. The rate of tissue formation provided by the graft and the grafts’ relative resistance to the hostile environment of the oral cavity support further clinical research to validate the use of these devices in oral reconstruction.

Characterising the use of full and split thickness skin grafts amongst dermatologists: An international survey.

Abstract Background The use of full-thickness and split-thickness skin grafts (FTSG/STSG) among dermatologists has not been well characterized. Objectives To characterize the utilization of graft techniques, fixation methods and training needs pertaining to graft use among an international cohort of dermatologists. Methods An online questionnaire was developed iteratively, and subsequently distributed between July and August 2022 to dermatologists from the UK, European countries and New Zealand (NZ). Results In total, 150 responses were obtained from the UK, Ireland, NZ, Australia, Brazil, USA and eight European countries. Among the respondents, 23.3% (35 of 150) undertook both FTSG and STSG; 46.7% (70 of 150) performed only FTSG; and 30.0% (45 of 150) did not undertake skin grafts in their practice. Of the 67 Mohs surgeons, only 42% (28 of 67) undertook both FTSG and STSG. Overall, common donor sites for FTSG included the preauricular area (86 of 105; 81.9%) and clavicle (75 of 105; 71.4%), while the thigh was the most common donor site for STSG (30 of 35; 86%). Grafts were fixed mostly with sponge tie-over dressings and basting/quilting sutures. For STSG, most were harvested using an electric dermatome (18 of 35; 51%), freehand skin-graft knife (17 of 35; 49%) and flexible razor blade (5 of 35; 14%). Of the total, 48.0% (72 of 150) considered skin grafting an essential skill in dermatology training, and most respondents cited a lack of training opportunity and insufficient surgical cases as significant barriers. Conclusions Our survey reveals diverse practices among an international cohort of dermatologists in the use of FTSG/STSG and highlights the need for further training.

A child developing alopecia areata at the scalp donor site after split-thickness skin grafting

A child developing alopecia areata at the scalp donor site after split-thickness skin grafting

The effectiveness of punch grafts in promoting the healing of surgical injuries and hard-to-heal wounds.

Punch grafting is a technique that can improve and accelerate the healing of hard-to-heal wounds and reduce the associated pain. It is a simple and inexpensive procedure that can be performed in the examination room. It is a technique that uses small split-thickness skin grafts (STSG) to promote the growth of epithelial tissue. It has been described as being used mainly to treat ulcers of venous, arterial, hypertensive and diabetic aetiology. Punch grafting has also been used successfully in postoperative dermatological surgical wounds. This article describes and details the performance of the punch-graft technique, with special emphasis on aftercare and the role of nurses in the procedure. A clinical case is presented of a patient who underwent surgery for cutaneous squamous cell carcinoma and whose primary closure was rejected. It was decided to place the STSGs obtained from the anterior aspect of the patient's thigh after preparation of the recipient area to ensure an optimal wound bed. The patient's pain subsided within a few days, and the wound healed within weeks with weekly dressing changes.

Clinical Analysis and Treatment Strategies About Cartilage Scaffold Exposure After Auricular Reconstruction With the Expanded Two-Flap Method.

Objectives: Soft tissue expansion is one of the main methods for autologous cartilage auricular reconstruction. The aim of this study was to analyze the risk factors for cartilage exposure after this method and to describe a surgical method for this complication. Methods: From January 2018 to December 2020, 853 patients (908 sides) underwent auricular reconstruction with an expanded two-flap method at our center. Thirty-two patients experienced cartilage exposure postoperatively. These patients were set as the case group, and 1:1 matched sampling was performed among patients who did not have cartilage exposure. The matched sample of 32 cases was set as the control group. All 64 patients were evaluated according to the Orbit, Mandible, Ear, Nerve, and Soft tissue (OMENS) classification system to analyze the correlation between cartilage exposure and hemifacial microsomia (HFM) and OMENS subtypes. The complication was repaired with superficial temporal fascial flap combined with skin graft. Results: HFM might be a risk factor for scaffold cartilage exposure, and there was a significant correlation between cartilage exposure and orbital malformation, facial nerve dysplasia, and soft tissue developmental malformation. The use of a superficial temporal fascial flap combined with a split-thickness skin graft to repair the complication achieved satisfactory outcomes. Conclusions: There is a correlation between cartilage scaffold exposure and the severity of HFM. Temporoparietal fascial flap transfer combined with skin grafting proved to be an effective method for cartilage exposure.

Local Control of Pyoderma Gangrenosum Using Human Amniotic Membrane and Transcriptome Analysis.

Pyoderma gangrenosum (PG) is a rare, chronic, ulcerative disease characterized by non-healing wounds that worsen with debridement, a phenomenon called pathergy. No consensus regarding pathogenesis, diagnosis, or treatment exists for PG. A previous pilot study using dehydrated human amniotic/chorionic membrane (dHACM), following excisional debridement, augmented PG wound healing and allowed for subsequent wound closure through split-thickness skin grafting (STSG). In this clinical trial (NCT05120726), four patients with an established PG diagnosis were enrolled to undergo treatment with dHACM and characterize the pre- and post-treatment transcriptome profiles. RNA sequencing was used to isolate the total RNA from specimens. Genes of particular interest were quantified through real-time quantitative reverse transcription polymerase chain reaction. We observed varied changes to the local expression of inflammatory response, positive regulators of cellular proliferation, and extracellular matrix disassembly cytokines. All PG wounds produced granulation tissue following treatment and were closed using split-thickness skin grafts.

Development of huge keloid at donor site and recurrent keloid at graft site after excision of pubic keloid followed by split-thickness skin graft: A case report.

Keloids are the result of abnormal tissue scarring that occur after skin injuries leading to pain, psychological distress, and impaired quality of life. Despite the high recurrence rate after surgical treatment, excision is often inevitable for symptom control. A 32-year-old female presented with a huge keloid on the pubic area accompanied by severe pain, pruritus, and infectious discharge. She also had multiple keloids on her chest and shoulders, indicating a strong predisposition to keloid formation. While high potential for recurrence was anticipated, surgical excision was inevitable for symptom control. Complete keloid excision followed by split-thickness skin graft was performed. Pathological report revealed keloid accompanied by ruptured epidermal inclusion cyst. Although postoperative care was highly recommended for prevention of keloid recurrence, the patient refused any additional management due to her financial difficulties. At postoperative 8 months, mild degree of keloid or hypertrophic scar at marginal area of the graft was observed, suggesting the potential sign of keloid recurrence. The patient voluntarily discontinued the outpatient follow-up for 2 years, and then returned with huge keloid not only at the graft site but also at the donor site. Keloid with inflamed epidermal inclusion cyst can cause severe pain where surgical excision is unavoidable, regardless of the high potential for recurrence. Additional postoperative care is necessary to prevent recurrence. Furthermore, attempts to minimize new keloid formation at the donor site after split-thickness skin graft, such as thin skin harvest or selecting the scalp as the donor site, should be considered.

Deep and Superficial Debridement Techniques in Lower Extremity Split-thickness Skin Grafting.

Patients with nonhealing lower extremity (LE) wounds often require a split-thickness skin graft (STSG) for closure. Nonviable tissue must be debrided before STSG inset. Our study aimed to compare differences in debridement depth on STSG outcomes. Chronic, atraumatic LE wounds receiving STSG from December 2014 to December 2022 at a single institution were reviewed. Demographics, wound characteristics, operative details, and outcomes were collected. Superficially debrided wounds were compared with wounds receiving deep debridement (DD), defined by debriding to the level of white tissue underlying the granulation tissue. Subanalysis was performed on wounds that had a negative and positive postdebridement culture. Primary outcome was graft failure. Overall, 244 wounds in 168 patients were identified. In total, 158 (64.8%) wounds were superficially debrided and 86 (35.3%) received DD. The cohort had a median Charlson Comorbidity Index of 4 [interquartile range (IQR): 3]. Diabetes (56.6%) and peripheral artery disease (36.9%) were prevalent. The only statically significant demographic difference between groups was congestive heart failure (SD: 14.9% versus DD: 3.0%, P = 0.017). Wound size, depth, and all microbiology results were similar between groups. Postoperatively, the DD group demonstrated significantly less graft failure (10.5% versus 22.2%, P = 0.023). In a multivariate regression, DD was independently associated with lower odds of graft failure (OR: 0.0; CI, 0.0-0.8; P = 0.034). Sub-analysis of graft failure supported this finding in culture-positive wounds (DD: 7.6% versus DD: 22.1%, P = 0.018) but not in culture-negative wounds (13.6% versus 22.2%, P = 0.507). The DD technique demonstrates improved outcomes in chronic, culture-positive LE wounds receiving STSG.

A Composite Application Technique of Single-stage Dermal Templates to Improve Handling and Ease of Use.

The "work horse" for the treatment of full-thickness defects of any etiology, including chronic nonhealing wounds and traumatic injuries, is generally autologous split-thickness skin grafts (STSGs), meshed, hand-fenestrated, or a sheet graft. Advancements in skin tissue engineering have allowed for the integration of dermal substitutes to be combined with autologous STSGs, adding valuable options for restoring the skin's complex multilayered structure. Although dermal templates offer a promising avenue for more nuanced reconstruction in certain cases, their application is not without challenges, particularly when they are made from delicate materials. The following technique simplifies the application technique of single-stage dermal templates by using a composite approach. To demonstrate this technique, MatriDerm, a 1-mm-thick bovine collagen-elastin dermal template, is used to enable an STSG to be applied in a one-stage procedure.

A Simple and Effective Approach to Defatting Large Surface Area Full-thickness Skin Grafts.

Skin grafting is a fundamental tool in plastic surgery for the resurfacing of wounds resulting from burns, necrotizing infections, trauma, oncologic resections, donor site defects, and other causes. Compared with split-thickness skin grafts, full-thickness skin grafts (FTSGs) undergo less secondary contracture and often result in better aesthetic outcomes. To assure graft take, FTSGs require thorough defatting and adequate contact between the graft and the underlying wound bed. Conventionally, during the defatting process, FTSGs are stabilized on the surgeon's fingers, whereas curved scissors are used to remove the subcutaneous tissue. This approach is effective for small grafts, but for large FTSGs, it is time-consuming and ergonomically challenging.

Split thickness skin graft transplantation inspired by paper-cutting: A feasible approach to mitigating surgical misorientation in vitiligo

Split thickness skin graft transplantation inspired by paper-cutting: A feasible approach to mitigating surgical misorientation in vitiligo

Topical Tranexamic Acid on Donor Wounds in Burn Patients: A Randomized Placebo-controlled Trial.

Patients with major burn injuries are prone to massive blood loss owing to tangential excision of burn wounds and donor skin harvesting. In general, topical application of the antifibrinolytic drug tranexamic acid (TXA) to surgical wounds reduces bleeding; however, its effect on bleeding and re-epithelialization in superficial wounds of burns has not been explored. This study aimed to investigate the therapeutic potential of topical TXA in reducing blood loss and its effect on wound re-epithelialization in burn surgery. Split-thickness skin graft donor wounds in burn patients were paired and randomized to topical application of either TXA (25 mg/mL) or placebo. Endpoints were postoperative bleeding as measured by dressing weight gain per cm2 wound area, blood stain area per wound area, and visual evaluation of bleeding in the dressings. Healing time was recorded to analyze the effect on wound re-epithelialization. There was no significant difference in bleeding or time to re-epithelialization between the TXA and placebo wounds. A post hoc subanalysis of wounds with dressing weight gain above the median, showed a significant difference in favor of TXA. However, use of tumescence may have influenced end points. No significant adverse events related to the study drugs were observed. This study demonstrates that topical application of TXA (25 mg/mL) to split-thickness skin graft donor wounds does not delay re-epithelialization. Although a reduction in bleeding is suggested, further studies are needed to determine the role of topical TXA in reducing bleeding in burn surgery.

Basic techniques for optimizing burn wound healing: insights from clinical practice

The purpose of this paper is to provide the author’s view on basic techniques to optimize burn wound healing. For burns that are partial thickness, the goal is to optimize re-epithelialization to reduce the chance of hypertrophic scarring. For deeper burns, there are principles that lead to better outcomes. For very small burns, such as on the hand, full-thickness skin grafts can be performed in the outpatient setting. For burns requiring split-thickness skin grafts, thicker grafts tend to contract less than thinner ones. Using wider skin grafts or breaking up straight seams with darts also leads to improved results. Choosing donor sites that either minimize scarring or can be hidden should also be considered. For the massive burn, one must still prioritize better grafts for more functional or cosmetic areas (face, hands). Early excision and coverage should reduce scarring. Despite the availability of newer technologies, simple strategies to treat the burn wound still lead to excellent results.

Evaluation of the Use of Negative Pressure Wound Therapy for Securing Split-Thickness Skin Grafts for Coverage of Chronic Wounds

Abstract Background Split-thickness skin grafting (STSG) is a versatile reconstructive option that has passed the test of time. However, many factors can cause poor graft take. Negative pressure wound therapy (NPWT) has transformed the management of complicated wounds and has been used as a means for securing split-thickness skin grafts (STSG). The role of NPWT in the fixation of grafts was compared to conventional Tie over bolster dressing. Aim of the Work To assess whether NPWT would result in a better graft take especially in wounds with large surface area. Patients and Methods This is a parallel group randomized control study. conducted from November 2021 to June 2022 in the Plastic, burns, and maxillofacial Surgery Department, Ain Shams University Hospitals. Block randomization of 52 patients into one of the two groups (NPWT vs. non-NPWT; 26 patients each) was done. Graft take/loss and length of hospital stay post-grafting were assessed. Results Mean graft take in the NPWT group was quantitatively and qualitatively better than that in the non-NPWT group. None of the patients in the NPWT group required a second coverage procedure. No major complication was encountered with the use of NPWT. Conclusion Compared with conventional tie over bolster dressing, NPWT is a simple, yet powerful and effective alternative in the integration of STSG. It significantly increases the rate of graft take especially in large wounds, while reducing rates of complications and hence re-operation.

Degloved foot sole successfully restored with split thickness skin grafts: A case report

Degloved foot sole successfully restored with split thickness skin grafts: A case report

Surgical outcomes of hidradenitis suppurativa: evaluating factors influencing recurrence and complications after 284 complete excisions

Abstract Background Hidradenitis suppurativa (HS) is a chronic inflammatory disorder associated with tunnel formation and scarring. Surgical excision is a potential curative therapy for HS. Objectives To characterize the surgical outcomes of patients with HS undergoing complete excision and to identify the risk factors associated with postoperative recurrence. Methods This retrospective 16-year cohort study enrolled patients 20 years or older who underwent complete excision for HS lesions at the National Taiwan University Hospital. We assessed the rates of postsurgical recurrence and complications, and estimated the odds ratio (ORs) with 95% confidence intervals (CIs) of their association with potential risk factors using generalized estimating equations. Results In total, 136 patients with HS and the 284 corresponding complete excisions were identified. Recurrence developed in 88 (31.0%) operations, while complications occurred in 102 (35.9%). Common types of complications included wound dehiscence, hypertrophic scars, and surgical site infection. Clinical factors associated with a lower risk of recurrence were male sex (aOR, 0.48; 95% CI, 0.23–0.98), operation at atypical locations (aOR, 0.28; 95% CI, 0.08–0.99), and wound repair by split-thickness skin graft (aOR, 0.31; 95% CI, 0.12–0.77). Wound dehiscence was associated with an increased risk of recurrence (aOR, 2.55; 95% CI, 1.21–5.42). No independent factors were identified as being associated with composite postoperative complications. Conclusions Complete excision alone is effective in curing HS in Asians. Recurrence developed in about one-third of the complete excisions performed for HS. Sex, operative locations, methods of wound repair, and wound dehiscence were major determinants for recurrence.

Repairing Exposed Tendon Wounds with Absorbable Gelatin Sponges and Autologous Split-Thickness Skin Grafts: A Case Series.

Conventional flap repair surgery has several drawbacks, including operational complexity, donor site damage, and high risk. In this case series, the authors explored an alternative approach for repairing exposed tendon wounds caused by trauma using absorbable gelatin sponges (AGSs) and autologous thigh skin grafts. This report presents two cases of lower-extremity skin necrosis with tendon exposure following wound debridement. The treatment approach involved early debridement, negative-pressure wound therapy, and wound irrigation with 0.9% sodium chloride. Upon achieving controlled wound infection, AGSs were applied to the exposed tendon to prevent degeneration and promote wound healing. Subsequently, areas where granulation tissue failed to cover the tendon were repaired using AGSs and 0.25-mm-thick autologous mesh skin grafts harvested from the thigh. Complete wound healing was achieved in both cases, on the 20th and 12th day after skin grafting, respectively. The proposed method proved successful in repairing exposed tendon wounds, effectively preventing infection and necrosis.

Conventional Bolster Dressing Versus Vacuum-Assisted Closure Device for Securing Split-Thickness Skin Graft in Contoured Wide Raw Area Reconstruction: A Randomized Clinical Trial

Conventional Bolster Dressing Versus Vacuum-Assisted Closure Device for Securing Split-Thickness Skin Graft in Contoured Wide Raw Area Reconstruction: A Randomized Clinical Trial

Versatility of Proximal Sural Island Sensate Fasciocutaneous Flap in Reconstruction of Soft Tissue Defects of Knee and Proximal Leg

Background: The proximal sural island sensate (PSIS) fasciocutaneous flap presents an ideal alternative in reconstruction of defects of the knee and proximal leg. It provides a thin sensate flap with good aesthetic outcomes and reduced donor site morbidity. However, only limited reports exist in the literature about this flap.Methods: This is a retrospective study done between December 2018 and December 2021 including 30 patients, among which seven cases had defects located on the knee and 23 cases in the proximal part of the leg. Mean age of the study population was 41 years. The maximum flap size was 8×12 cm, while the maximum pedicle length was 15 cm.Results: All 30 flaps survived well with only minimal complications occurring in a few patients such as epidermal loss and distal tip necrosis. No arterial or venous crisis occurred postoperatively in any case. Donor sites were managed with one-stage primary closure or split-thickness skin grafts. Functional deficits were not detected in any of the cases.Conclusion: We found the PSIS fasciocutaneous flap to be a simple and reliable technique to perform. The flap offers extensive coverage, reaching from the knee to the proximal leg, and provides thin, pliable, and sensate skin, resulting in excellent aesthetic and functional outcomes.

The role of reconstructive plastic surgery in the treatment of victims of the 2023 Kahramanmaraş earthquake

Objective: As a result of the 2023 Kahramanmaraş earthquake, medical institutions experienced a large influx of patients requiring acute multidisciplinary surgical and medical care. This study aimed to evaluate the patient demographics and treatment management of survivors admitted to our reconstructive plastic surgery department. Materials and Methods: We retrospectively analyzed the age, sex, time under the wreckage, time of admission, types and locations of injuries, treatment modalities, receipt of hyperbaric oxygen therapy, and receipt of vacuum-assisted closure therapy of the earthquake victims referred to our department. Results: The definitive management of all 42 earthquake survivors admitted to our department was reviewed. This included five free flaps, four regional flaps, 18 split-thickness skin grafts, and one maxillofacial fracture repair. Eight patients were treated conservatively including two with non-displaced maxillofacial fractures. Of the 26 patients treated for lower extremity injuries, four were already amputees. Among the remaining 22 patients with such injuries, one underwent Charcot amputation plus free flap reconstruction to preserve extremity length and one underwent below-the-knee amputation. Of the 16 upper extremity injuries, two patients referred with extensive forearm necrosis underwent forearm amputation. To preserve extremity length and ensure the limbs were suitable for biomechanical orthoses, free transverse upper gracilis musculocutaneous flaps and free chimeric Anterolateral- Vastus Lateralis musculocutaneous flaps were performed. Conclusion: This study illustrates the value of multi-modal reconstructive plastic surgery in the treatment of disaster survivors, particularly in the management of multi-trauma.