Total Skin Graft Research Articles

The effect of T-lysine cream on the wound healing process

Background and objective: Wound healing is a dynamic process that can be compromised in patients with chronic and metabolic conditions or unhealthy lifestyles. Objectives of study is to demonstrate a hyaluronate-containing supramolecular structure which enhances repalysYAL®cream effectiveness, sodium chloride with thymine (T-LysYal®); 1) notable progress in the healing of wounds. 2) the production of minuscule collagen strands 3) a shorter recovery period. Methods: Case study, the test group received standard treatment followed by lysine cream to indicate the size and depth ulcer from the 1st week to the 3rd week. Our patients were a 1-year child and 29 years old male who presented with a second degree of total body surface area (TBSA) burn and skin grafts at the burn center of Rozhawa Hospital/ Hawler/Iraq. The observations were approved by the Ethics committee college of pharmacy in compliance with the ethical standard. Initially assessed as superficial partial-thickness in-depth, the wounds were treated conservatively with dressings and repalysYAL® cream 2-3 times per day; however, represents the healing process in short-term individual therapy. Results: In case 1; The patient had been exposed to flash deep burn to the right palm (thermal injury) mainly of superficial partial thickness; any necrotic tissue present needs to be removed to take full advantage of the product’s potential. When (repalysYAL®) cream is used, there will be a physiological increase in the exudate, which will have to be managed to avoid maceration. While in case 2;The patient presented surgical wound dehiscence in the inner compartment of the left foot with leakage of purulent material and signs of necrotizing fasciitis. with using (repalysYAL®) cream, the wound reduces scar formation due to 90% and increase fibroblast by 30% when a blood vessel is formed to which blood is supplied, the cells are cultivated and divided to form new tissue and an organ. Conclusion: Signaling pathways that induce cellular and tissue responses after injury, which may be impeded during chronic wound healing, were greatly improved using lysine cream as a therapy.

Résultats à long terme des greffes de peau plantaire versus greffes de peau des zones velues pour la couverture des pertes de substances cutanées de la face palmaire des doigts, de la paume de main et de la plante du pied chez les patients à peau noire. Étude de cohorte prospective de 123 greffes de peau totale

Despite the use of total skin grafting in the treatment of loss of skin substances on the palmar surface of the fingers, the palm of the hand and the sole of the foot, the data published in the literature on long-term results in black-skinned patients are non-existent. The present study, filling this gap, used data from a prospective cohort of 123 total skin grafts performed on 93 black African patients who benefited from plantar skin grafts versus skin grafts from hairy areas to cover loss of skin substances. of the palmar surface of the fingers, the palm of the hand and the sole of the foot. This study covers a period of 163 months. Sixty-four grafts of hairy areas were carried out in 52 patients, 29 of whom were male and 23 female, for a M/F sex ratio of 1.3; and 59 plantar skin grafts in 41 patients including 21 males and 20 females, M/F sex ratio of 1. The digital palmar surface was the most recipient of the plantar graft, i.e. 35.5% of cases. After a post-operative follow-up of at least 12 months, patients or their entourage judged the functional and aesthetic results of plantar skin grafts to be better and acceptable, unlike the results of hairy area grafts. The texture and color are even better if the total skin graft is taken from an identical histological area. In view of these results, we recommend a plantar skin graft for black-skinned patients to cover losses of skin substances on the palmar surface of the fingers, the palm of the hand and the sole of the foot, if indicated.

Surgical management of giant skin tumor – A case report

Malignant non-melanoma skin cancers (NMSC) are of two main types: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). In rare occasions, some of the malignant skin lesions show histopathological characteristics of both BCC and SCC and are known as basosquamous carcinomas (BSC). In some cases of large tumors, extensive reconstructive surgery might be needed to correct the skin defect after the primary excision. We report a case of a 76-year-old Bulgarian male patient who presented with a neglected giant cutaneous tumor with more than a 15-year history of a growing mass in the right deltoid area. On physical exam an enormous exophytic ulcerated and crusted skin lesion measuring around 11×11cm was found. Wide local excision of the lesion with 10-mm resection margins and partial resection of the underlying deltoid muscle were performed due to signs of infiltration. A full-thickness total skin graft from the left inguinal area was harvested to cover the skin defect. Final histopathological examination showed metatypical carcinoma with mixed characteristics of SCC and BCC-BSC, with infiltration of the fatty tissue, deltoid muscle and clear margins of resection, staged as T4R0. Two and a half years after surgery there are no signs of upper arm motor dysfunction and no evidence of local recurrence and distant metastasis on a follow-up PET/CT. Following current National Comprehensive Cancer Network's guidelines for primary treatment of BCC, surgical candidates should undergo standard excision with wider surgical margins, postoperative margin assessment and second intention healing, linear repair, or skin graft. Therapeutic strategy for non-operable cases includes administration of radiotherapy or system therapy in the face of Hedgehog pathway inhibitors and programmed cell death protein 1 inhibitor. They can provide an alternative solution to unresectable or difficult-to-treat locally advanced cases of BSC. Similarly to BCC and SCC, the first-line treatment option for BCS is surgical excision, but surgical margins should be wider than those for low-risk BCC due to the infiltrative growth pattern of this tumor. Favorable esthetic outcome requires precise planning of the reconstructive technique.

Escalade thérapeutique devant un cas d’hyperkératose nævoïde de l’aréole et du mamelon

Nevoid hyperkeratosis of the nipple areola complex (NAC) is a rare dermatological pathology of unknown etiology, first described in 1923. It is a benign condition characterized by verrucous thickening and brownish discoloration of the NAC. We described the case of a 26-year-old woman with bilateral nevoid hyperkeratosis of the NAC. Several lines of treatment have been used with varying efficacy: conservative (calcipotriol and local retinoids), semi-conservative (CO2laser) and surgical (excision and total skin graft). The final result is very satisfactory and without recurrence at 1year follow-up.

Usefulness of elastic compressive dressing on total skin graft in lower limbs: a series of two cases

Reconstruction with grafting for defects resulting from the removal of squamous cell carcinoma in the lower limbs is a great challenge for the dermatological surgeon. A very thin skin for the receiving area, the inhomogeneity of the local vascularization and the transient venous insufficiency make it difficult to integration of the grafted skin in these regions. For the success of this type of procedure, some techniques can be used to repair these difficulties, such as an elastic compressive dressing that we use in the first postoperative days of a total skin graft on the foot and leg, with good results

Consensus of free flap complications: Using a nomenclature paradigm in microvascular head and neck reconstruction.

We aim to define a set of terms for common free flap complications with evidence-based descriptions. Clinical consensus surveys were conducted among a panel of head and neck/reconstructive surgeons (N=11). A content validity index for relevancy and clarity for each item was computed and adjusted for chance agreement (modified kappa, K). Items with K < 0.74 for relevancy (i.e., ratings of "good" or "fair") were eliminated. Five out of nineteen terms scored K < 0.74. Eliminated terms included "vascular compromise"; "cellulitis"; "surgical site abscess"; "malocclusion"; and "non- or mal-union." Terms that achieved consensus were "total/partial free flap failure"; "free flap takeback"; "arterial thrombosis"; "venous thrombosis"; "revision of microvascular anastomosis"; "fistula"; "wound dehiscence"; "hematoma"; "seroma"; "partial skin graft failure"; "total skin graft failure"; "exposed hardware or bone"; and "hardware failure." Standardized reporting would encourage multi-institutional research collaboration, larger scale quality improvement initiatives, the ability to set risk-adjusted benchmarks, and enhance education and communication.

Reconstructive surgery for sequellae of Mycobacterium ulcerans infection (Buruli ulcer) of the upper limb

Introduction Infection by Mycobacterium ulcerans constitutes a neglected tropical disease whose prevalence seems to have overrun those of cutaneous tuberculosis and leprosy. Its aggressivity depends on a mycolactone toxin. Lesions may involve skin, tendon and bone with a large spectrum of manifestations: non-ulcerative (papules, nodules, plaques), ulcerative and oedematous presentations as well as osteomyelitis with muscular contraction and ankylosis. Upper limbs account for more than two thirds of the infection sites. Surgical treatment may involve tendon transpositions, partial and total skin grafts. Amputation is relegated to extreme cases. Material and methods Selected iconography from patients during the last 15 years is presented. At least 1500 cases had partial skin grafts (anterior thigh). Total skin grafts (inguinal region) were used in about 200 cases. Complex lesions involved 9 ilioinguinal flaps (5 boys, 4 girls, mean age 11.2 years, range 2–16 years), 5 tendon transfers (4 boys, one girl, mean age 15.4 years, range 12–19 years) and 3 resections of the first carpal row (2 girls, 1 boy, mean age 8 years, range 4–15 years). Results and discussion Out of 9 ilioinguinal flaps mild, marginal necrosis was the only complication in 2 patients without flap loss. Mean hospital stay was 26.44 days (range, 18–41 days), with return to full weight-bearing after a mean of 12 weeks (range 9–25 weeks) after discharge. Functional thumb opposition to allow pencil prehension was achieved in all three cases of resection of first carpal row resection without postoperative complications.

Retrospective analysis of the effects of radiotherapy on the areolas reconstructed with a total skin graft

Retrospective analysis of the effects of radiotherapy on the areolas reconstructed with a total skin graft

Comparison of scald burns caused by hot water, tea and milk in preschool children

Aim: Burn injury is an important health problem with physical, psychological and economic effects with children being affected the most. The aim of this study is to present the epidemiological and demographic data and clinical results of preschool pediatric patients with scald burns which are treated in a tertiary reference burn center.Materials and Methods: Preschool children admitted between January 2014 and August 2019 was included in the study. The demographic and epidemiological data, burn etiology, percentage of burned total body surface area and treatment results of patients were evaluated retrospectively from the patient files and the hospital registry.Results: A total of 1010 preschool children with scald burns were treated in our burn center from January 2014 to August 2019. Patients were grouped by the etiology as; group 1: water, group 2: tea and group 3: milk scalds. There were 628 patients in group 1, 304 in group 2 and 78 in group 3. The percentage of burned total body surface area was higher for scalds with milk and was found as 15.54±12.1 and the difference was statistically significant. The intensive care and the total hospital stay were also higher in scalds with milk. There were similar results with infection, grafting and mortality rates as being higher in the milk group. Conclusion: The majority of preschool patients in our burn center were scalds with water but the percentage of burned total body surface area, skin grafting and complication rates were higher in scalds with milk. Childhood burns were usually seen indoors at preschool period, necessitating training programs for family members supervising these children and raising the awareness of parents.

Total full-thickness skin grafting for treating patients with extensive facial burn injury: A 10-year experience

IntroductionFacial burns are not only a severe burn injury, but result in psychological disturbance. The improvement of the methods of treating facial burns remains topical. The aim of the study was to evaluate the effectiveness of approach based on full-thickness skin autografting for facial burn injuries. MethodsDuring 2000–2019, ninety seven patients with the facial burn were treated in Burn Center. All patient were divided into two groups. The comparative analysis between groups was done. ResultsGroup A was treated with full-thickness skin grafts (42 patients – 43.3%). Since 2010, total full-thickness skin graft was used in 11 patients from Group A. In group B, 55 patients (56.7%) were treated with split-thickness skin grafts, including 9 patients (16.4%) with total split-thickness skin graft transplantation. Total full-thickness skin graft was performed in case of a deep and extensive facial burn and cicatricial deformities. During the long-term period, a positive cosmetic result and the absence of indications for reconstructive operations were noted. ConclusionThe approach of facial burn treatment based on total full-thickness skin graft allows conditions for engraftment and adaptation of autograft, reduces the risk of scar developing and achieves maximum cosmetic results of treatment.

Prise en charge des séquelles de brûlure palmaire chez l’enfant, à propos de 49 cas

Even if they represent only 2.5% of the total body surface area, the hands are burnt in 50% of hospitalized patients. The risk of sequelae is significant, especially in children, human being in full growth, and a source of aesthetic and functional handicap. The aim of this study is to research the predictive factors of sequelae, to study their treatment of and their evolution. We included children under six years of age with deep palmar burns of the hand between 1998and 2008. Demographics, characteristics of the initial burn and its treatment were noted. Then, we studied the types of hand burn sequelae and their treatment. Finally, we observed their evolution over time with an aesthetic and functional evaluation and their impact on quality of life. Forty-nine children, representing 70hands, were included in the study. The mean age at the time of the initial burn was 16.2months (6; 60). The initial treatment was directed healing in 39% of cases and thin skin excision-grafting in 61% of cases. The type of sequelae most represented was bridle in 73% of cases. Treatment consisted of rehabilitation measures (13%) or surgery (69%). The mean age at the time of surgery was 10.1years (4; 19). These were plasties (62%), total skin grafts (15%) or a combination of both (23%). The current follow-up is 16.2years. The aesthetic result is considered good in 52% of cases, the functional result is good in 78% of cases. The impact on the quality of life is low and the parents are satisfied with the initial care. The treatment of the sequelae of burnt hands gives good results but involves well-conducted rehabilitation and regular monitoring. The treatment period must be adapted and the surgery simple, effective and specific to the type of sequelae.

Effects of photobiomodulation therapy in the integration of skin graft in rats.

Skin graft is one of the most common techniques used in plastic surgery and repair. However, there are some complications that can lead to loss of the skin graft. Thus, several features have been studied with the aim of promoting the integration of skin grafts. Among these resources, the use of laser photobiomodulation (laser PBM) has been highlighted. The present study aimed to investigate the effects of laser PBM on the viability and integration of skin grafts in rats. Twenty male Wistar rats (± 250 g) were randomly assigned into two experimental groups with 10 animals each: control group, animals submitted to skin graft and simulation of laser PBM; laser PBM group, submitted to the skin graft and submitted to laser PBM at 660 nm, 40 mW, 60 s, 2.4 J. The animals were submitted to laser photobiomodulation immediately after the surgical procedure and each 24 h. Animal euthanasia occurred on the 7th day after surgery, 24 h after the last treatment session. The histopathological analysis revealed that the laser PBM showed better adhesion of the graft when compared to the control group. Likewise, the morphometric analysis of mast cells, blood vessels, and collagen showed a statistically significant increase in the animals irradiated with the laser PBM when compared to the control group. In addition, immunohistochemical analysis demonstrated that the laser PBM showed statistically higher immunoexpression of FGF when compared to the CG. However, IL-4 immunoexpression did not show statistical difference between the experimental groups. From the results obtained in the present study, it can be suggested that laser photobiomodulation was effective in promoting the integration and viability of total skin grafts in rats.

Effect of High Voltage Pulsed Current on the integration of total skin grafts in rats submitted to nicotine action

ObjectiveThe aim of this study was to evaluate the impact of High Voltage Pulsed Current (HVPC) on the integration of total skin grafts in rats submitted to nicotine action. Materials and methodsFor this purpose, 60 adult Wistar rats randomly distributed in 6 groups of 10 animals were analyzed. The electrical stimulation (anodic and cathodic stimulation, motor level, 30 min at 10 Hz; minimum voltage 20 μs and 100 μs pulse interval) was applied for seven days, starting on the third day after surgery and after the dressing was removed from the graft. ResultsAnodic HVPC promoted greater graft integration, demonstrating a lower percentage of tissue contraction, a lower number of inflammatory infiltrates and a greater amount of vascular endothelial growth factor (VEGF), as well as a higher number of newly formed blood vessels. ConclusionsHVPC can positively influence the integration of skin grafts in nicotine-treated rats. anodic HVPC is shown to promote greater integration in relation to a lower percentage of tissue contraction, a lower number of inflammatory infiltrates and a greater amount of vascular endothelial growth factor and newformed blood vessels. Whereas, the cathodic polarity has presented smaller amount of tissue gap.

Periorbital necrotising fasciitis secondary to scratching

An 80 year-old woman with no relevant medical history, consulted for worsening of right palpebral itching and pain after an insect bite. Her eyelids had areas of laceration due to scratching, which rapidly progressed to fibrinoid necrosis over the first 24hours. Lesions were cultivated, revealing Streptococcus pyogenes and Staphylococcus aureus. The patient was admitted to hospital with the diagnosis of periorbital necrotising fasciitis, in order to receive treatment with intravenous ceftriaxone, linezolid, and immediate surgical debridement. She remained in hospital for 17 days. Daily wound management consisted of debridement of necrotic remains, disinfection with chlorhexidine, and wound dressing with mupirocin, sulfadiazine, and miconazole ointments. The patient suffered streptococcal toxic shock syndrome, but she recovered over the first week. Palpebral reconstruction was performed on day 15, consisting of a preauricular total thickness skin graft for the superior eyelid, and lateral malar advancement to cover the lower eyelid. Adequate cosmetic and functional results were obtained.

Fascitis necrosante periorbitaria secundaria a rascado

An 80 year-old woman with no relevant medical history, consulted for worsening of right palpebral itching and pain after an insect bite. Her eyelids had areas of laceration due to scratching, which rapidly progressed to fibrinoid necrosis over the first 24hours. Lesions were cultivated, revealing Streptococcus pyogenes and Staphylococcus aureus. The patient was admitted to hospital with the diagnosis of periorbital necrotising fasciitis, in order to receive treatment with intravenous ceftriaxone, linezolid, and immediate surgical debridement. She remained in hospital for 17 days. Daily wound management consisted of debridement of necrotic remains, disinfection with chlorhexidine, and wound dressing with mupirocin, sulfadiazine, and miconazole ointments. The patient suffered streptococcal toxic shock syndrome, but she recovered over the first week. Palpebral reconstruction was performed on day 15, consisting of a preauricular total thickness skin graft for the superior eyelid, and lateral malar advancement to cover the lower eyelid. Adequate cosmetic and functional results were obtained.

La reconstruction de l’aréole et du mamelon

The reconstruction of the nipple-areolar complex is the final stage of breast reconstruction that restores the visual identity of the breast. The most common options for reshaping the areola are tattooing, total skin grafting of the inner thigh and the total skin graft taken from the contralateral areola. Nipple reconstruction solutions include duplication of contralateral nipple, local flap, total skin graft and tattoo in three-dimension. Duplication of the nipple is the technique of choice because it immediately offers optimal color, texture and projection. The areolar tattoo is the most common procedure for its simplicity and reproducibility.

Unplanned readmission after hospital discharge in burn patients in Iran.

Burns are considered as one of the most serious health problems throughout the world. They may lead to adverse consequences and outcomes. One of these outcomes is unplanned readmission. Unplanned readmission has been commonly used as a quality indicator by hospitals and governments. This study aimed to determine the predictors of unplanned readmission in patients with burns hospitalized in a burn center in the North of Iran (Guilan province, Rasht). This retrospective analytic study has been done on the medical records of hospitalized patients with burns in Velayat Sub-Specialty Burn and Plastic Surgery Center, Rasht, Iran during 2008-2013. In general, 703 medical records have been reviewed but statistical analysis was performed on 626 medical records. All data were entered in SPSS (version 16) and analyzed by descriptive and inferential statistics. Among 626 patients with burns, the overall readmission rate was 5.1%. Predictors of readmission included total body surface area (OR 1.030, CI 1.011-1.049), hypertension (OR 2.923, CI 1.089-7.845) and skin graft (OR 7.045, CI 2.718-18.258). Considering the outcome, predictors following burn have a crucial role in the allocation of treatment cost for patients with burns and they can be used as one of the quality indicators for health care providers and governments.

A rare\xa0case of\xa0failed healing in previously burned skin\xa0after a\xa0secondary burns

BackgroundPatients presenting with large surface area burns are common in our practice; however, patients with a secondary large burn on pre-existing burn scars and grafts are rare and not reported.Case presentationWe report on an unusual case of a patient sustaining a secondary large burn to areas previously injured by a burn from a different mechanism. We discuss the potential implications when managing a case like this and suggest potential biological reasons why the skin may behave differently. Our patient was a 33-year-old man who presented with a 5% TBSA burn on skin scarred by a previous 40% total body surface area (TBSA) burn and skin grafts. Initially assessed as superficial partial thickness in depth, the wounds were treated conservatively with dressings; however, they failed to heal and became infected requiring surgical management.ConclusionsBurns sustained in areas of previous burn scars and grafts may behave differently to normal patterns of healing, requiring more aggressive management and surgical intervention at an early stage.

MatriDerm Decreases Donor Site Morbidity After Radial Forearm Free Flap Harvest in Transgender Surgery

BackgroundPhalloplasty with the radial forearm free flap is associated with a large donor site defect. AimTo compare two methods of donor site closure for functional and cosmetic long-term results: full-thickness skin grafting vs split-thickness skin grafting with MatriDerm. MethodsThirty-seven transgender patients had a neophallus created from a radial forearm free flap, and all were operated on by the same senior surgeon. Eight patients had their donor site defect closed by total skin grafting and 29 patients, operated on after 2009, received a split-thickness skin graft with MatriDerm closure. All 37 patients were evaluated by questionnaire and by careful clinical examination. Pressure perception was assessed with the Semmes-Weinstein monofilament test. Sensory recovery, skin quality, and cosmetic result also were compared. The contralateral arm was used as the control. OutcomesPressure perception values showed better sensory return in the MatriDerm group. Split-thickness skin grafting with MatriDerm achieved superior results in skin sensibility, superficial radial nerve recovery, and cosmetic aspect. ResultsOur findings support the hypothesis that MatriDerm can be used to preserve sensory function and decrease morbidity of the donor site. Clinical ImplicationsThe use of a dermal substitute decreases the morbidity of the forearm free flap donor site. Strengths and LimitationsThe strength of this study is its retrospective nature conducted of a prospectively maintained database of 37 consecutive radial forearm free flaps with superimposable dimensions and location performed by the same surgeon, thus limiting biases. A limitation is its small sample (particularly for the control group). ConclusionOur experience showed that the combination of a split-thickness skin graft with MatriDerm substantially decreases postoperative complications at the donor site defect on the forearm of transgender patients.Watfa W, di Summa PG, Meuli J, et al. MatriDerm Decreases Donor Site Morbidity After Radial Forearm Free Flap Harvest in Transgender Surgery. J Sex Med 2017;14:1277–1284.

A new technique for creating a neo-umbilicus in abdominoplasty

The umbilicus is an essential feature of the abdomen. In this article, we describe a new technique for creating a neo-umbilicus in abdominoplasty. Thirty consecutive women underwent abdominoplasty with our new technique for recreating the navel. The new navel is created at the midpoint between the xiphoid process and pubic symphysis by defatting a cylinder of fat tissue as far as the dermis that is then sutured to the rectus muscle to enable it to "take" in the same way as a total skin graft and form a hollow, which will be the new navel. Patients were divided into three groups according to BMI (group A<25; group B 25-29.9; group C≥30). Results were rated on a scale of 0-10 by external observers and by the patients. Complications were recorded. Groups B and C obtained median scores of 10/10 from both the external raters and patients (range 1), while group A obtained median scores of 6/10 and 7/10, respectively (ranges 6 and 5). Our new technique presents a series of advantages: it allows the positioning of the new navel in any location, it does not create periumbilical scarring, and it can be used in cases in which the original pedicle and vascularization of the navel cannot be preserved. It appears to achieve good aesthetic results and high levels of satisfaction among patients; however, it is less effective in very thin patients whose navel remains flat due to the lack of adipose tissue.