Thin Split-thickness Skin Graft Research Articles

Vitiligo: Surgical Repigmentation of Leukotrichia

Patients with vitiligo frequently have premature gray hair. Until recently the literature was silent about its management. While surgically treating vitiligo, we incidentally observed repigmentation of gray hair. Based on our observations we undertook this study to see the effect of surgical treatment of vitiligo on repigmentation of leukotrichia, as well as to evaluate the percentage of repigmentation, if any, in the different hair-bearing areas, and the time taken for it. A case series of eight patients with nine patches of localized, stable, and refractory vitiligo with leukotrichia of 3-12 years duration is presented. The patients were followed up for 2-6 years. One patient was lost from follow-up after 2 months. The vitiligo was treated by dermabrasion and thin split-thickness skin grafting under local anesthesia, as outpatients. Repigmentation of the hair occurred in all the areas but it was seen earlier (3 months) and was more complete in the eyebrows (70-95%). In the scalp and the beard areas it started later (6-9 months) and was around 50-60% only. The degree of pigmentation increased until about 3 years after surgery. No complications in the form of graft loss or alopecia were observed. Partial to near-total repigmentation of leukotrichia can be achieved surgically. Contrary to the present theory, we hypothesize that melanocytes also migrate from the repigmented epidermis to the hair follicle, resulting in repigmentation of the hair.

Preparation of Recipient Areas When Skin Grafting for Camouflage of Static Localised Vitiligo

SummaryA prospective randomized study was undertaken in 50 patients with static localised vitiligo to determine the optimum thickness of the excision of patches of vitiligo prior to grafting with normally pigmented very thin split-thickness skin grafts.Recipient areas (diseased skin) were prepared in 1 of 5 different ways (n = 10 per group): Group 1, dermabrasion of epidermis alone; Group 2, shaving of thin partial-thickness skin; Group 3, shaving of medium partial-thickness skin; Group 4, excision of full-thickness skin alone and Group 5, excision of full-thickness skin with subcutaneous fat.After a minimum follow up of 6 months, results showed that in Groups 1 and 2, the skin grafts desquamated by the re-growth of epidermis from the recipient bed. In the Group 3, grafts were unsightly because of retention cysts and a prominent edge. In Group 5, grafts became hyper-pigmented and the grafted area was scalloped. Optimum results were obtained in Group 4 with best aesthetic appearance. Vitiligo patches are best treated by excision of full-thickness skin when resurfacing with normally pigmented thin split-thickness skin grafts.

A reliable method for monitoring the microvascular patency of free jejunal transfers in reconstructing the pharynx and cervical esophagus.

Reconstruction of the pharynx and esophagus with revascularized segments of jejunum remains a time-proven entity. Most thromboses and subsequent flap failures have occurred within the first 24 hours after revascularization of the flap. What would therefore be desirable is a safe, proven monitoring system to assess the patency of the microvascular anastomoses and subsequent viability of the transferred bowel segment. This paper reports on such a monitoring system, which involves the creation of a surgical window on the anterior cervical flap. The jejunal serosa is tacked to this window, and a thin split-thickness skin graft is placed directly on the bowel. The technique is simple, safe, efficacious, and leaves no significant defect.

Complications of surgery for radiotherapy skin damage.

Complications of modern surgery for radiotherapy skin damage reviewed in 28 patients who had 42 operations. Thin split-thickness skin grafts for ulcer treatment had a 100 percent complication rate, defined as the need for further surgery. Local flaps, whether delayed or not, also had a high rate of complications. Myocutaneous flaps for ulcers had a 43 percent complication rate, with viable flaps lifting off radiated wound beds. Only myocutaneous flaps for breast reconstruction and omental flaps with skin grafts and Marlex mesh had no complications. The deeper tissue penetration of modern radiotherapy techniques may make skin grafts and flaps less useful. In reconstruction of radiation ulcers, omental flaps and myocutaneous flaps are especially useful, particularly if the radiation damage can be fully excised. The pull of gravity appears detrimental to myocutaneous flap healing and, if possible, should be avoided by flap design.

THE CARE OF OPEN INJURIES OF THE HAND AND FINGERS WITH SPECIAL REFERENCE TO THE TREATMEN OF TRAUMATIC AMPUTATIONS

The most practicable and certain primary method for general use in the repair of traumatic amputation of digits is a cover by a thin split-thickness skin graft, when necessary after anterior shortening of the exposed phalanx. This free graft repair is relatively unsightly and poorly sensitized; but it is much more reliable and its performance needs less experience than a full-thickness skin-graft cover. The best repair for these common important finger-tip injuries is one by like tissue,—that is, by a thenar or palmar flap. When properly executed, these flaps show no disability in the donor sites, give the best-looking stumps and the best return of sensation to them.