Tie-over Dressing Research Articles

Clinical use of 0.1% polyhexanide and propylbetaine on acute and hard-to-heal wounds: a literature review.

To summarise the findings on the effect of the clinical use of 0.1% polyhexanide-propylbetaine (PHMB/betaine) solution/gel on acute and hard-to-heal (chronic) wound healing. A literature search was conducted in MEDLINE, CINAHL, Embase, Scopus and the CENTRAL Trials Registry of the Cochrane Collaboration. Paired reviewers conducted title and abstract screening and full-text screening to identify experimental, quasi-experimental and observational studies. Study quality and risk of bias were not formally evaluated. A total of 17 studies met the eligibility criteria. The findings from 12 studies indicated that the use of 0.1% PHMB/betaine solution/gel had: a low risk of contact sensitivity; could help debridement during wound cleansing; aided effective wound bed preparation; reduced wound size, odour and exudate; improved pain control; reduced microbial load; and enhanced wound healing. The results of three studies indicated that both 0.1% PHMB and saline solution were effective in reducing bacterial load, while another showed that adding 0.1% PHMB to tie-over dressings had no effect on reducing bacterial loads in wounds. Another study concluded that disinfection and granulation of pressure ulcers with hydrobalance dressing with 0.3% PHMB was faster and more effective than using 0.1% PHMB/betaine. The findings of this literature review showed that 0.1% PHMB/betaine solution/gel appeared to be useful and safe for wound cleansing, was effective in removing soft debris and slough from the wound bed, and created a wound environment optimal for healing. Although these actions cannot be attributed solely to this treatment modality, these results do highlight the unique action of this combined product. However, more robust studies are needed to confirm these results.

Cross‐finger flap as ultima ratio for the reconstruction of defects of the finger flexor sides

Cross‐finger flap as ultima ratio for the reconstruction of defects of the finger flexor sides

A buccal mucosal graft subcoronal resurfacing technique to treat recurrent penile adhesions: the buccal belt.

To outline our step-by-step surgical technique using a subcoronal buccal mucosal graft (BMG) resurfacing technique for the treatment of recurrent penile adhesions. To perform the 'buccal belt' procedure a subcoronal circumferential segment of diseased skin was excised. An appropriately sized BMG was circumferentially secured subcoronally with a proximal and distal anastomosis to the edges of the wound. Quilting stitches were also placed to allow proper graft fixation. A petroleum jelly bolster was secured as a tie-over dressing. Patients were discharged with a Foley catheter and the bolster dressing in place. The bolster and Foley catheter were removed 7 days postoperatively. The patients were then seen for follow-up at 4- to 6-month intervals. A retrospective, international multi-institutional review was conducted to include all patients who underwent this procedure. Surgical complications, evidence of recurrence, and patient-reported outcome measures including visual analogue scale (VAS) and global response assessment (GRA) questionnaires were reviewed. Thirty-one men underwent the procedure across six institutions between March 2014 and September 2020. The mean (range) surgical time was 59 (25-95) min. At the mean (range) follow-up of 27 (4-79) months all patients reported resolution of presenting symptoms and no recurrence of adhesions. The mean VAS score was 8.9 and 9.0 for aesthetics and functional outcomes, respectively. On GRA, overall improvement was reported by all patients (61%, +3; 25%, +2; 14%, +1). There are limited options for the treatment of recurrent penile adhesions. A subcoronal BMG resurfacing is feasible, with no recurrence and overall high satisfaction seen in an initial patient cohort.

V10-04 A BUCCAL MUCOSAL GRAFT SUB-CORONAL RESURFACING FOR TREATMENT OF RECURRENT PENILE ADHESIONS: THE BUCCAL BELT

You have accessJournal of UrologyLower Tract Reconstruction (V10)1 Sep 2021V10-04 A BUCCAL MUCOSAL GRAFT SUB-CORONAL RESURFACING FOR TREATMENT OF RECURRENT PENILE ADHESIONS: THE BUCCAL BELT Matthew Beamer, Javier Angulo, Leandro Capiel, Damian López-Alvarado, Erick Ramirez-Perez, Paksi Satyagraha, Daniel Zaccarini, and Dmitriy Nikolavsky Matthew BeamerMatthew Beamer More articles by this author , Javier AnguloJavier Angulo More articles by this author , Leandro CapielLeandro Capiel More articles by this author , Damian López-AlvaradoDamian López-Alvarado More articles by this author , Erick Ramirez-PerezErick Ramirez-Perez More articles by this author , Paksi SatyagrahaPaksi Satyagraha More articles by this author , Daniel ZaccariniDaniel Zaccarini More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002061.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrent penile adhesions often cause pain, post-coital bleeding, disfigurement and patient distress. Treatment options are limited and include topical steroids, lysis of adhesions and repeat circumcisions. Furthermore, adhesions are often associated with Lichen Sclerosus (LS) limiting the use of skin in any reconstruction. We present a novel surgical procedure using a sub-coronal buccal mucosal graft (BMG) resurfacing technique. METHODS: To perform the buccal belt procedure a sub-coronal segment of affected skin, approximately 1.5 cm in width, was circumferential excised. The circumference of the penile shaft was measured and an appropriately size buccal mucosal graft was harvested. The graft was placed sub-coronally and secured circumferentially with a proximal and distal anastomosis. Buck’s fascia was included in both the anastomosis and quilting sutures to allow for appropriate spread fixation of the graft. A vaseline gauze bolster was secured as a tie-over dressing. Patients were discharged with the bolster dressing and foley catheter. They were seen 7 days postoperatively for removal and then at 4-6 month intervals for follow-up. A retrospective, international multi-institutional review was conducted to include all patients treated with this technique. Surgical complications and evidence of recurrence were recorded. Patient-reported outcome measures including visual analog scale (VAS) and Global Response Assessment (GRA) questionnaires administered to measure functional and esthetic outcomes were also reviewed. RESULTS: Thirty-one men underwent the procedure across six institutions between 3/2014 and 9/2020. Mean age was 56.3 (32-77) and prior treatments included: topical agents 14 (45%) and circumcision 25 (81%). LS was seen in 23(74%) patients. Mean surgical time was 59 (25-95) minutes and mean hospital stay was 0.65(0-2) days. At the mean follow-up of 27 (4-79) months no patients developed recurrence. No patients reported painful erections. Mean VAS was 8.9 and 9.0 for esthetics and functional outcomes respectively. On GRA overall improvement was reported by all patients (61% +3; 25% +2; 14% +1). The majority saw improvement in esthetic appearance (46% +3; 39% +2; 7% +1; 4% 0; 4% -1) and improvement with post-coital bleeding (43% +3; 43% +2; 4% +1; 11% 0). Ninety-six percent would recommend the procedure to a friend. CONCLUSIONS: There are limited options for the treatment of recurrent penile adhesions, particularly in the setting of LS. A sub-coronal BMG resurfacing is feasible, with no recurrence and overall high satisfaction seen on an initial patient cohort. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e756-e756 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Beamer More articles by this author Javier Angulo More articles by this author Leandro Capiel More articles by this author Damian López-Alvarado More articles by this author Erick Ramirez-Perez More articles by this author Paksi Satyagraha More articles by this author Daniel Zaccarini More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement Loading ...

The use of gauze-based negative-pressure wound therapy with Y-connector for dressing full-circumference skin grafts on both lower limbs.

Free skin grafts have long been used as an essential surgical procedure to treat skin defects due to burns, trauma or illness, requiring skin transfers from sufficient, non-marked areas. Usually, free skin grafts are covered by simple pressure dressings or tie-over dressings. However, under conditions of wide, concave or irregular wounds, graft removal has been problematic due to instability. We report a case in which gauze-based negative-pressure wound therapy using a Y-connector was indicated for the opportunity to cover both limbs with free skin grafts all around, providing successful wound care.

Outcomes of split vs full-thickness skin grafts in scalp reconstruction in outpatient local anaesthetic theatre.

BackgroundSurgical excision remains the cornerstone of simultaneous diagnosis and treatment of suspicious skin lesions, and the scalp is a high-risk area for skin cancers due to increased cumulative lifetime ultraviolet (UV) exposure. Due to the inelasticity of scalp skin, most excisions with predetermined margins require reconstruction with skin grafting.MethodsA retrospective single-centre cohort study was performed of all patients undergoing outpatient local anaesthetic scalp skin excision and skin graft reconstruction in the Plastic Surgery Department at Addenbrookes Hospital over a 20-month period between 1 April 2017 and 1 January 2019. In total, 204 graft cases were collected. Graft reconstruction techniques included both full-thickness and split-thickness skin grafts. Statistical analysis using Z tests were used to determine which skin grafting technique achieved better graft take.ResultsSplit-thickness skin grafts had a statistically significant (P = 0.01) increased average take (90%) compared to full-thickness skin grafts (72%). Using a foam tie-over dressing on the scalp led to a statistically significant (P = 0.000036) increase in skin graft take, from 38% to 79%.ConclusionIn skin graft reconstruction of scalp defects after skin cancer excision surgery, split skin grafts secured with foam tie-over dressings are associated with superior outcomes compared to full-thickness skin grafts or grafts secured with sutures only.

To Tie or Not to Tie-Over Full-Thickness Skin Grafts in Dermatologic Surgery: A Systematic Review of the Literature.

Tie-over dressings are frequently used for skin grafts. Although a dressing is necessary for split-thickness skin grafts, their use in full-thickness skin grafts (FTSGs) is questionable. This review was conducted to investigate the influence of different tie overs and dressings on graft take for FTSGs in cutaneous surgery. An electronic database search was performed in MEDLINE, EMBASE, Web of Science, and the Cochrane library. The following search terms and comparable were used: skin transplantation, tie-over, fixation, sutures, and take. Fifteen articles met the inclusion criteria. Eight studies describe no use of a tie-over dressing for FTSGs. Dressing types included antibacterial dressings, foam or sponges, and bolsters. The lowest graft take was 80% (with a tie-over dressing). The highest graft take was 100% (with and without a tie-over dressing). The results show that, regardless of the technique used, the overall graft success rate is high. Although a definite recommendation could not be made, it seems that a graft without a tie-over dressing can suffice in certain circumstances.

Full-thickness Skin Graft Fixation Techniques: A Review of the Literature.

Multiple techniques for skin graft fixation have been proposed, but the evidence underlying these techniques is unclear. This study aimed to review the literature for full-thickness graft fixation techniques. PubMed was electronically searched to identify relevant studies. The search strategy identified 91 relevant articles. These consisted of 2 randomised controlled trials (RCTs), 10 observational cohort studies (8 retrospective, 2 prospective), and 79 descriptive studies (case series, case reports, or expert opinion articles). Both identified RCTs compared the tie-over dressing against a modified tie-over dressing. The tie-over dressing was also included in all identified observational studies, and comparisons were made against quilting/mattress suturing (4 studies, 181 grafts in total), simple pressure dressings (3 studies, 528 grafts), non-tie-over dressings non-specifically (1 study, 71 grafts), hydrocolloid dressings (1 study, 62 grafts), and double-tie over dressings (1 study, 43 grafts). No significant differences were found between fixation methods for graft take, haematoma rate, and infection rate. No studies have found a significant difference between tie-over dressings and alternative graft fixation technique, with the most evidence for simple pressure dressings and quilting/mattress suturing. However, the evidence base consists mostly of small, retrospective observational studies. This article describes the current evidence base and this should be considered when planning future reports in the field.

Inflammation Biomarkers and Correlation to Wound Status After Full-Thickness Skin Grafting.

Background: A surgical site infection (SSI) is believed to be the result of an exaggerated inflammatory response.Objective: Examine the relationship between clinical status and inflammation biomarkers in full-thickness skin grafting wounds.Methods: Twenty patients planned for facial full-thickness skin grafting were enrolled. A week after surgery, all graft wounds were clinically assessed using a 3-step scale for inflammation (low, moderate, high). All wounds were swabbed for routine microbiological analysis and assessment of numbers of aerobic bacteria. Tie-over dressings from all patients were collected and used for wound fluid extraction and subsequent analysis of MMPs, cytokines, and NF-κB inducing activity.Results: Wounds with a high degree of inflammation contained increased total MMP activity (P ≤ 0.05) in their corresponding fluids. Likewise, the level of the cytokines IL-1ß, IL-8, IL-6, TNF-α was analyzed, and particularly IL-1ß was discriminatory for highly inflamed wounds (P ≤ 0.01). Moreover, bacterial loads were increased in highly inflamed wounds compared to wounds with a low degree of inflammation (P ≤ 0.01). NF-κB activation in the monocytic cell line THP-1 was significantly higher when these cells were stimulated by wound fluids with a high degree of inflammation (P ≤ 0.01). Growth of S. aureus in wounds did not vary between wounds with different degrees of inflammation (chi-square 3.8, P = 0.144).Conclusion: Biomarkers analyzed from tie-over dressings correlated to clinical wound healing in full-thickness skin grafting.

Classification pattern and step-by-step procedure for cartilage grafts with silicone implants for nasal tip plasty in Asians

Dorsal augmentation using silicone and tip plasty with autogenous cartilage is commonly performed in Asians. No study has investigated the classification pattern and step-by-step procedure for tip plasty using silicone implants. Therefore, this study classified cartilage grafts using silicone implants in Asians and developed a step-by-step procedure for their implementation. The study included 39 patients who had undergone augmentation rhinoplasty with a silicone implant combined with a conchal cartilage graft as a shield, an onlay graft, or both. We classified the implant-conchal cartilage complex into two main types (edge and no-edge types). In the edge type, the shield graft tip was located 1-2mm above the silicone implant or onlay graft. In the no-edge type, it was located at the same level as the silicone implant or onlay graft. Each type was classified into three groups depending on the number of onlay grafts: group I, 0; group II, 1; and group III, ≥2. The cartilage complex was placed on the dorsum. The conchal cartilages were harvested through a post-auricular incision while preserving the radix helicis as cartilage bars. The donor site was closed primarily without a tie-over dressing. Of the 39 patients, 35 were satisfied with the outcome. Three revision operations for implant displacement and one revision for a patient who changed her dorsal height preference were performed. No donor site morbidity occurred. This method may be safe and reliable, with minimal morbidity associated with graft harvesting for tip plasty in Asians.

Optimal Result of One-Stage Secondary Debulking Procedure After Flap Reconstruction of the Ankle.

Since January of 2004 to June of 2016, 22 one-stage secondary debulking procedures were performed on 22 patients who had received reconstruction with flaps for ankle defects. Nineteen cases were free myocutaneous flaps, 2 cases were free fasciocutaneous flaps, and 1 case was a distally based sural artery flap. In the operative technique, the full-thickness skin was harvested from the flap and regrafted on the defatted fascia with tie-over dressing. The functional and cosmetic outcomes as well as complications were reviewed. The overall mean follow-up time was 12 months. After the debulking procedure, all of the grafted skins took well. The patients were able to wear their own shoes without difficulty and regained ease of ambulation. The reconstructed area was found to decrease to an average of 28.92% as compared with predebulking area. The reconstructed ankles achieve good symmetry with regard to the contralateral side (P < 0.05). All of the patients were satisfied with the results of the reconstructed ankles. The 1-stage secondary debulking procedure is a safe and reproducible technique that achieves good functional and aesthetic outcomes after flap reconstruction of the ankle.

Effectiveness of double tie-over dressing compared with bolster dressing.

BackgroundSkin grafting is a commonly performed operation in plastic and reconstructive surgery. The tie-over dressing is an effective technique to secure the grafted skin by delivering persistent downward pressure. However, if an additional dressing is required due to incomplete graft healing, the process of re-implementing the tie-over dressing may be frustrating for both patients and surgeons. Therefore, we introduce the double tie-over dressing, which readily allows for an additional tie-over dressing after the first dressing, and we present a comparison of its effectiveness with that of the simpler bolster dressing.MethodsOf 128 patients with a skin defect, 69 received a double tie-over dressing and 59 patients received a simple bolster dressing. Using the independent t-test, the mean healing time, which was defined as the mean time it took for the wound to heal completely so that no additional dressing was required and it was washable with tap water, was compared between the 2 groups in both the head and neck region and in other areas.ResultsThe mean healing time for the head and neck region in the double tie-over dressing group was 9.19±1.78 days, while it was 11.05±3.85 days in the bolster dressing group. The comparison of the 2 groups by the independent t-test revealed a P-value of 0.003 for the mean healing time.ConclusionsIn the head and neck area, the double tie-over dressing required less time to heal than the simple bolster dressing.

Original and modified technique of tie-over dressing: Method and application in burn patients

In burn patients, meshed split thickness skin grafts are commonly used on large and non-flat areas whom immobilization is difficult to achieve. The frequent mobilizations of burn patients can make the graft slip and prevent the revascularization and therefore the taking of the skin graft. In order to prevent this pitfall, we modified and adapted the tie-over dressing procedure. The giant running tie-over dressing enables large skin grafts to be applied to their wound bed and therefore helps revascularization. Some cautions are necessary in order to avoid any infection. This original and easy-to-perform procedure answers to the difficulties of large split-thickness skin grafts in burn patients.

Investigating the use of tie‐over dressing after skin grafting

Tie-over bolster dressing after skin grafting can prolong operative time, and cause hematoma and seroma formation because of uneven pressure application. To describe the possibility of discontinuing the use of tie-over dressing, we carried out a retrospective comparative study of patients who underwent skin grafting at an institution between January 2009 and December 2014. We investigated and compared the take rate, healing period, wound infection rate and hematoma formation rate for the tie-over dressing group and the non-tie-over dressing group. Among 266 patients, 148 and 118 patients were included in the tie-over dressing group and non-tie-over dressing group, respectively. There were no significant differences between the take rate, healing period, wound infection rate and hematoma formation rate for the two groups. Multivariate analysis showed that the complete graft take rate was not significantly influenced by tie-over dressing, age, sex, graft site, graft procedure and skin graft diameter. Although the use of tie-over dressing might remain necessary on sites with a free margin, including the eyelids, lips or nostrils, because of the difficulty in using tape fixation, the present study showed that alternative dressing with polyurethane foam is also useful in most cases of skin grafting.

Can dressings soaked with polyhexanide reduce bacterial loads in full-thickness skin grafting? A randomized controlled trial

Polyhexamethylene biguanide (PHMB)-based antiseptic solutions can reduce bacterial loads in different clinical settings and are believed to lower risk of infections. We sought to assess the efficacy of a PHMB-based solution in lowering bacterial loads of full-thickness skin grafting wounds and the risk of surgical site infections (SSIs). In this double-blinded clinical trial, 40 patients planned for facial full-thickness skin grafting were randomized 1:1 to receive tie-over dressings soaked with either PHMB-based solution or sterile water. Quantitative and qualitative bacterial analysis was performed on all wounds before surgery, at the end of surgery, and 7days postoperatively. In addition, all patients were screened for nasal colonization of Staphylococcus aureus. Analysis of wounds showed no statistically significant difference in bacterial reductions between the groups. The SSI rates were significantly higher in the intervention group (8/20) than in the control group (2/20) (P=.028). Higher postoperative bacterial loads were a common finding in SSIs (P=.011). This was more frequent when S aureus was present postoperatively (P=.034), intraoperatively (P=.03), and in patients with intranasal S aureus colonization (P=.007). Assessment of SSIs is largely subjective. In addition, this was a single-center study and the total number of participants was 40. Soaking tie-over dressings with PHMB solution in full-thickness skin grafting had no effect on postoperative bacterial loads and increased the risk of SSI development. The presence of S aureus intranasally and in wounds preoperatively and postoperatively increased postoperative bacterial loads, which in turn resulted in significantly more SSIs.

A Simple Dressing Technique Following Dermofasciectomy and Full Thickness Skin Grafting of the Fingers in the Treatment of Severe Dupuytren's Contracture.

Dupuytren's disease with severe finger contractures and recurrent contractures following previous surgery often have extensive skin involvement. In these severe cases, excision of the diseased chord along with the involved skin is a good option to reduce the risk of recurrance. The resulting skin defect can be covered with a full thickness skin graft (FTSG) or a cross finger flap. Cross finger flaps have donor finger morbidity and hence a full thickness graft is usually preferred. The FTSG extending to the midlateral margins on both sides of the finger reduces the risk of joint contracture due to graft shrinkage. Once the FTSG is sutured in place, the standard practice is to compress and secure the graft to its recipient bed with a tie-over dressing and this can be time consuming. We present a simple dressing technique to secure the FTSG without the need for a tie-over dressing.

Abstract: Nail Bed Defect Reconstruction Using Thenar Fascia Flap and Nail Bed Graft

INTRODUCTION: Split-thickness nail bed graft is the most preferred treatment option for covering nail bed defects.1 However, full-thickness loss of nail bed soft tissue precludes direct graft placement because there is no vascular wound bed for the graft to take.2 To cover such exposed distal phalanx and provide a graft bed, we used thin thenar fascial flaps. In this case series, we present our approach to such refractory defects using a two-stage operation. MATERIALS AND METHODS: Between 2014 and 2016, thenar fascial flaps and nail bed grafts were used in five patients. All the patients had full-thickness nail bed defects due to machines or door jamming incidents, and the sizes of the defects were more than half of the whole nail bed. We designed the flaps as general thenar flaps, performed suprafascial dissection, and elevated the dermal flaps proximally. We then performed subfascial dissection over the thenar muscle from the proximal to the distal direction and turned over the only fascial layer and inset onto the defects. After 2 weeks, the flap was divided, and a split-thickness nail bed graft was taken from the big toe. Tie-over dressings were performed, and the donor sites closed primarily. RESULTS: All flaps survived completely, and all split-thickness nail bed grafts were well taken. The mean follow-up period was 11 months. Nail growth was observed to the end of the distal nail bed without non-adherence, and the overall shape of the new nail was symmetrical to the corresponding finger nail of the contralateral hand. Cosmetic outcomes were excellent. The big toe nail showed partial non-adherence initially, but improved with time. None of the patients experienced any other complications. CONCLUSION: Full-thickness nail bed defects, especially with bony exposures, are difficult to operate with satisfactory results. The thenar fascia flap is extremely thin, yet performs admirably as a wound bed for split-thickness nail bed grafts. Morbidity is minimal at both the thenar and great toe donor sites. Functional and cosmetic outcomes are excellent. It could be an excellent treatment option for these kinds of cases. REFERENCES: 1. Brown RE, Zook EG, Russell RC. Fingertip reconstruction with flaps and nail bed grafts. J Hand Surg Am. 1999 Mar;24(2):345–51. 2. Zook EG. Anatomy and physiology of the perionychium. Hand Clin. 2002 Nov;18(4):553–9

Functional and cosmetic outcome after closure of radial forearm free flap donor defect with porcine collagen membrane.

Disadvantages of the radial forearm free flap (RFFF) are related to the forearm donor site, which requires skin grafting for closure. Due to that matter, an alternative technique using porcine collagen membrane instead of skin grafting was considered and evaluated for its efficacy of donor defect closure. Ten patients requiring reconstruction of oral & maxillofacial defect underwent the single-staged reconstruction with the RFFF. The flap was elevated and the porcine collagen membrane (Rapiderm(®)) was fixed at the donor site with tie-over dressing. After leaving it for at least 2 weeks, it was replaced with an iodine-coated furazine gauze for continuous healing. The patients did not develop any tendon exposure or infection. All forearms healed within 1 month. The mean graft size harvested was 27.75±3.08cm(2). A greater amount of granulation tissue was formed under the dressing gauze which resulted in a less conspicuous donor site. After 6 months the average scar dimension was 9.48±1.07cm. Appearance was excellent with good wrist motility and skin color. The use of the porcine collagen membrane in the donor site of the RFFF is an alternative approach with less morbidity compared to other techniques. Nevertheless, further studies with a larger number of patients are needed to validate the present findings.

Antimicrobial-impregnated dressing combined with negative-pressure wound therapy increases split-thickness skin graft engraftment: a simple effective technique.

Immobilization and adequate surface contact to wounds are critical for skin graft take. Techniques such as the tie-over dressing, cotton bolster, and vacuum-assisted closure are used to address this, but each has its limitations. This study is designed to assess the effect of antimicrobial-impregnated dressing (AMD) combined with negative-pressure wound therapy (NPWT) on skin graft survival. Retrospective case-control study : Patients with chronic or contaminated wounds treated with split-thickness skin graft. A broad spectrum of wounds was included, from causes such as trauma, burns, chronic diabetic ulcers, and infection. Antimicrobial-impregnated dressing, which contains 0.2% polyhexamethylene biguanide, with NPWT MAIN OUTCOME MEASURE:: Success of skin graft : In the AMD group, all skin grafts achieved 100% take without secondary intervention. No infection or graft failure was observed in any patients, and no complications, such as hematoma or seroma formation, were noted, although in the control group partial loss of skin grafts was noted in 3 patients. Infection and inadequate immobilization were thought to be the main reasons. There were no hematoma or seroma formations in the control group. Use of an AMD dressing with NPWT after split-thickness skin grafting can be an effective method to ensure good graft to wound contact and enhances skin graft take in chronic and contaminated wounds.

The Running Barbed Tie-over Dressing.

Summary:Barbed suture technology is becoming increasingly popular in plastic surgery and is now being used in body contouring surgery and facial rejuvenation. We describe the novel application of a barbed suture as a running tie-over dressing for skin grafts. The barbs act as anchors in the skin, so constant tensioning of the suture is not required. The bidirectional nature of the suture prevents any slippage, and the barbs even act as a grip on the underlying wool dressing. Furthermore, the method described is both quick and simple to learn and would be useful for the sole operator.