Thin Split Skin Grafts Research Articles

Novel Classification of Posttraumatic Ear Deformities and its Surgical Management.

Background Classification of posttraumatic ear deformities and its reconstruction is an uphill task for a reconstructive surgeon as they present in various combinations. In our study, we have described ear deformity as per a new classification and reconstructed the ear accordingly. Method Posttraumatic ear deformity was described under the following four headings: (a) zone of defect, (b) size of defect, (c) missing components, and (d) condition of surrounding skin. Twenty-six posttraumatic ear deformities were operated using postauricular skin flap (14), temporoparietal fascial (TPF) flaps (8), preauricular skin flap (1), intralesional excision (2), and primary closure with chondrocutaneous advancement in one patient. Costal cartilage was used for reconstruction of framework wherever required. Framework elevation was done 4 to 6 months postoperatively. Results Posttraumatic ear deformity was more common in males. Bite injury and road traffic accidents were the common causes. Zones I, II and III were most frequently involved. Four patients complained about size, contour, and projection of reconstructed ear. Three patients were not satisfied by the appearance of junction between reconstructed and residual ear. Four patients in whom the reconstruction was done with TPF, costal cartilage, and thin (SSG) split skin grafts complained of hyperpigmentation of reconstructed ear. Conclusion Classification of posttraumatic ear deformity and its reconstruction is a surgical challenge. Unscarred postauricular skin and TPF flaps are the workhorse flaps for reconstruction of acquired ear deformities. Our classification helps in describing the defect, documenting it, planning reconstruction, and aiding in assessing postoperative outcomes.

Surgical Reconstruction of Complex Distal Foot Defects With Vascularized Fascia Lata

BackgroundReconstruction of distal foot defect remains a challenge in plastic surgery. The purpose of this report is to present a new procedure that repairs these defects in severe burn patients. Results of application and follow-up in 7 patients were presented.MethodsFrom January 2016 to March 2018, a total of 7 patients (age ranging from 21 to 57 years) with distal foot defects were treated in our department. All the wounds were caused by severe burns and repaired by the free vascularized fascia lata combined with thin split-skin graft. After the operation, the status of the fascia flaps and grafted skin was observed, and follow-up information and complications were documented.ResultsAmong the 7 patients, the flaps and grafted skins completely survived in 5 patients. One patient was found to have grafted skin necrosis in the perioperative period, and 1 patient was found to have partial flap necrosis in the follow-up period. After conventional dressing treatment and skin grafting, the wounds healed in both patients. The mean follow-up was 6 months.ConclusionsThe method of combining the free vascularized fascia lata with thin split-skin graft represents a satisfactory approach for the repairing of distal foot defects.

Isotopic Split-skin Graft for Resurfacing of Deliberate Self-harm Scars.

Summary:We present a novel surgical approach for the revision of deliberate self-harm scars. The isotopic skin graft technique employs the harvest of a thin split-skin graft from the affected area, excision and closure of wide dermal scars with replacement of the graft back onto the harvest site. We present the sequential steps of the surgical technique and a case series of 2 patients treated with our novel approach.

Repair of deep tissue defects in the posterior talocrural region using a superficial temporal fascia free flap plus thin split-skin grafting in extensively burned patients: A retrospective case series.

The aim of this study was to describe the scheme, surgical procedures, and clinical outcomes for the early repair of deep wounds of the posterior talocrural region in extensively burned patients with a method combining a superficial temporal fascia free flap with thin split-skin grafting.From January 2013 to February 2016, 9 extensively burned patients with deep tissue defects of the posterior talocrural region were treated in our department (2 patients had bilateral deep tissue defects of the posterior talocrural region). All 11 wounds were repaired using a superficial temporal fascia free flap and thin split-skin grafting. After the operation, survival of the fascia flaps and grafted skin was observed, and the appearance and functional recovery of the grafts were evaluated. Follow-up information was reviewed, and complications were documented.All 11 fascia flaps survived completely. Two cases of partial skin necrosis healed after the second application of skin grafts. The appearance and function of recipient sites were well restored in all patients over a follow-up period of 5 to 14 months.Deep tissue defects of the posterior talocrural region can be effectively repaired with our method combining a superficial temporal fascia free flap with thin split-skin grafting. This method offers the advantages of a good appearance, strong resistance to infection, minimal damage at the donor site, short course of disease, and good prognosis.

Comparison of Repigmentation of Stable Vitiligo via Punch Grafting, Thin-thiersch’s grafting and Suction Blister Grafting

Background: Vitiligo is defined as an acquired melanocytopenia of obscure aetiology and is characterized by circumscribed hypomelanosis and depigmentation of skin and hair which is often progressive. The aim of present study is to compare between 3 surgical modalities i.e. miniature punch grafting, thin split-skin thickness grafting and suction blister grafting and to experiment a novel method according to the site, size and location of the lesion and to study the extent of re-pigmentation after doing these procedures and comparison of the results in patients of stable vitiligo. We also aim to assess the complications and disadvantages of different surgical techniques. Methods: The study was conducted on total 60 vitiligo patients, who were divided into 3 groups of 20 each, in the age group of 15-60 years, attending Dermatology Department of Katihar Medical College in the span of 2 yearsResults. Results are comparable overall but vary considerably according to site of lesions. Punch grafting is very good for mobile areas like elbow, ankle and other joints; Thin – thiersch’s skin grafting gives better results for flat areas like trunk, thigh, arms and face while Suction blister grafting gives satisfactory results for lips vitiligo and also over small, oval lesions over flat sites. Conclusions: Thus, it can be finally concluded from this study that the surgical modality for treating a case of vitiligo cannot be generalized. Every patient should be evaluated individually according to anatomical site involved, size and shape of lesion, time required to achieve pigmentation, infrastructure available and patient’s preferences.

A minimally invasive, scarless technique of donor tissue harvesting for noncultured epidermal cell suspension transplantation in vitiligo

SURGICAL CHALLENGE Noncultured epidermal cell suspension transplantation is a well-established technique in vitiligo surgery. Epidermal cells are harvested from a thin split skin graft, which results in some degree of permanent scarring, and it is not possible to take another graft from the same site in the subsequent sessions of surgery. In addition, if the graft is thick, trypsin digestion may take a long time, and separation of epidermis from dermis may not be easy.

Absence of pathological scarring in the donor site of the scalp in burns: An analysis of 295 cases

Aim This study aims to describe the incidence of complications on scalp from which a thin split-skin graft was harvested (0.005–0.007 in.) of the donor site in children and adult burn victims. Methods We reviewed the medical records of 295 burn patients admitted in the Burn Unit of the Clinical Hospital of the Faculty of Medicine of Ribeirão Preto, from January 1998 to December 2007, whose scalps were used as donor site for grafts. Skin-graft thickness varied from 0.005 in. to 0.007 in. The occurrence of pathological healing was evaluated clinically and the time of epithelisation by the main surgeon and a plastic surgeon or a staff nurse. Results Of the 295 patients whose scalps were used as donor site, 274 were followed from 6 months to 10 years after the procedure (median 18.2 months). Twenty-one patients were lost to follow-up in the first 6 months. No hypertrophic scarring or keloids on the donor site was observed. Five patients (1.82%) presented with folliculitis and two of them were evaluated with small areas of alopecia (0.7%), treated with resection of these areas and primary suture. The average time of epithelisation of the donor site was 7 days. Conclusion The harvest of thinner split graft from the scalp is a safe procedure.

Modifying integra as a regeneration template in deep tissue planes

Contour defects resulting in deformity caused by lack of tissue can be improved by conventional surgery using autologous tissue, but there is always a donor site morbidity. Integra has been available since the early 1980's for use in acute burns and more recently in reconstruction. It has been shown histologically to act as a tissue regeneration template. The regenerated dermis is buried under an autologous thin split-skin graft. In this study, the principle of burying Integra (without the silicone layer) has been applied to deep tissue defects in 12 reconstructive cases. Such regenerated tissues survive at least 3 years after burying. Modification to the technique to avoid visible edges are being developed.

Reconstruction of burn deformity using artificial dermis combined with thin split-skin grafting

Twelve patients with post-burn contracture were treated using artificial dermis combined with thin split-skin grafting during the period January 1994 to April 1996. Bilayer artificial dermis was grafted onto full thickness open wounds of the skin, after excision of scar contracture tissue. About 3 weeks later, the silicone layer was removed and thin split-skin, 8 1000 in. thick, was grafted onto the newly synthesized dermis-like tissue in the wound bed. Scalp was chosen as the donor site in 11 of the 12 cases. Artificial dermis grafting was undertaken to ensure that morbidity at the donor site could be reduced as much as possible in the treatment of burn deformity. The skin grafts took completely in all cases. Postoperative management was performed in accordance with conventional skin grafting. Postoperative contraction or hypertrophic scar was observed in three cases, but a soft, favorable quality was obtained in the other nine cases. Treatment of burn deformity with artificial dermis may be beneficial in selected cases.

An alternative treatment for the split skin-graft donor site.

There are a variety of methods employed in the postoperative management of the partial thickness donor site created during harvest of a split thickness skin graft. Each technique may be associated with potential complications of fluid loss, excessive pain, prolonged period for healing and delayed mobility, hypertrophic scarring, undesirable pigment aesthetics, and thin skin poorly resistant to everyday trauma. Thompson, and Converse and Robb-Smith have previously shown improved donor site outcome with the application of thin split skin grafts. Based on these studies, we present a technique that involves 1.5:1 meshing of a split skin graft and dividing it into equal halves so that one half is used to cover the defect and the other half is immediately returned to the donor site. Patients who are elderly, debilitated, or who have thin, poor-quality skin can expect less discomfort, reduction of fluid loss, improved durability and elasticity, and lower incidence of hypertrophic scarring with the proposed donor site regrafting.

口くう領域の上皮内がんの２症例

An intraepithelial carcinoma (carcinoma in situ) is characterized by marked cellular pleomorphism and by loss of polarity and surface stratification, with the whole thickness of the epithelium showing malignant cellular features. However, the basement membrane is intact.In this paper, 2 cases of intraepithelial carcinomas in the oral region are presented.Case 1: A 71-year-old man visited our clinic complaining of a white lesion in the floor of the mouth. The lesion was excised and thin split skin grafting was done under local anesthesia.Case 2: A 68-year-old woman visited our clinic complaining of a white lesion with erosion in the right margin of the tongue. The lesion was excised under general anesthesia. Afterwards, radiotherapy by Linac and 60Co were added.Pathologic diagnoses of the excised specimens of both patients were intraepithelial carcinomas.Postoperative course was satisfactory.

The use of thin split-skin grafting after diagnostic — therapeutic tumour removal

In cases of superficial tumours of suspected malignancy, a biopsy was not performed, but the tumour was excised completely, together with the surrounding healthy tissue. The tissue removed was used for histological diagnosis, and the wound was closed with a thin split-skin graft, which has the advantage of permitting early detection of any recurrent malignancy.

Radiation-sterilized split skin: a new type of biological wound dressing. A preliminary report.

Thin split skin grafts from human cadavers have been killed and sterilized by irradiation (4 ± 1 Mrad). This issue has successfully been used as a biological dressing on donor areas, second and third degree burns. It reduces the evaporation from the wound surfaces by 85%. Electron microscopic investigation shows that the horny layer of the dead tissue is well preserved in spite of the heavy irradiation, which explains the beneficial properties of this biological dressing.

A modification of the braithwaite knife

Since this time several modifications have been made. In x949 Bodenham reintroduced the disposable blade, doing away with the tedious sharpening previously necessary. In I955 Braithwaite published his modification of the Humby knife, which incorporated a cam action control of thickness, and a shorter, more rigidly held blade to control whip. When cutting thin split skin grafts, however, with the Braithwaite knife there is a tendency for the skin to roll up round the guard, and although this can be corrected by an assistant's traction on the cut skin, this man(euvre is liable to tear the sheet of skin or cause the knife to cut out. To remedy this disadvantage Watson in I96O produced a knife with a fixed, polished, stainless-steel guard and a simpler, more rigid thickness adjustment. While this fixed guard effectively dealt with the problem of skin rolling around the guard it introduced a considerable degree o f drag , due to the inability of the guard to slide to and fro with the skin surface. This drag is only partially eliminated by lubrication with liquid paraffin, and the edges of both graft and donor site tend to be rather ragged when a Watson knife has been used.

Pilonidal sinus carcinoma

1. 1. The previously reported seven cases of malignant change in an area of pilonidal disease are reviewed and an additional case presented. 2. 2. Wide excision of the primary lesion with primary operative defect coverage with a thin split-skin graft and groin dissection for palpable lymphadenopathy are presented as the current management of squamous cell carcinoma arising in an area of pilonidal disease.