Use Of Full-thickness Skin Grafts Research Articles

Skin grafting with the modified Meek technique in the standing horse using full thickness skin: Evaluation of acceptance, wound contraction and wound closure in chronic wounds.

The modified Meek technique is not commonly used in equine wound management, despite the consistent reliable and superior results compared with other grafting techniques. Major drawbacks are the need for specialised, expensive equipment and general anaesthesia. To describe adjustments of the modified Meek technique enabling use in the standing horse without the need for the full equipment. This implied the use of full-thickness skin grafts manually harvested from the pectoral area and manually cut into micrografts. Graft acceptance; healing progress; and final functional and cosmetic result were outcome parameters. Descriptive case series. Eight horses with traumatic wounds at the dorsal side of the carpus or tarsus, healing by second intention, were treated. Original wound areas and areas of graft acceptance and rejection were determined from post-processing of digital photographs and percentage acceptance, wound contraction and epithelialisation were calculated. The initial mean wound area was 55.4 cm2 . Graft acceptance was 95.3 ± 2.5%. Wound closure was due to 46.0 ± 25.6% wound contraction and 54.0 ± 25.6% epithelialisation and resulted in 96.8 ± 1.9% reduction of the initial wound area 28.0 ± 8.5 days after grafting. The scar was flat, flexible and functional, usually with thin and regular hair growth. The adapted procedure was fast and efficient, with a learning curve for the increased manual work. Small study population. This adapted modified Meek technique can successfully be performed in the standing horse and obviates the need for the full expensive equipment and general anaesthesia. The acceptance of the full-thickness grafts is excellent resulting in fast and satisfactory healing.

A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen

A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen

Full-thickness skin grafts to reinforce the abdominal wall: a cross-sectional histological study comparing intra- and extraperitoneal onlay positions in mice.

In the repair of complex abdominal wall hernia, there can be a strong preference to avoid synthetic or biological implants as reinforcement material. Autologous full-thickness skin grafts (FTSG) have shown promising results. However, there are few clinical data on the use of FTSG in an intraperitoneal position and rudimentary knowledge about postoperative histological appearance of tissue remodelling and repair. To investigate the histological appearance of FTSG in the intraperitoneal onlay mesh (IPOM) position. Isogeneic FTSG was positioned in the IPOM (10 mice) and the onlay position (10 mice). After eight weeks, tissues were harvested for histological analysis. Tissue structure, inflammation and cell survival were investigated with histological and immunohistochemical staining. Morphology was similar in both positions. Luciferase staining indicated both onlay and IPOM graft cell survival, with microvascular networks present. In both positions, FTSG showed ongoing tissue remodelling processes and cystic formations containing hair and epidermis. Low-grade acute phase and chronic inflammation were present. Integration was observed in 50% of the mice with similar appearances in IPOM and onlay grafts. FTSG is tolerated, with comparable results either inside or outside the abdominal cavity, and in line with historic histological evaluations. The results suggest further research on FTSG as a potential future reinforcement material in selected cases of complex abdominal wall hernia repair.

Long-term functional outcomes upon application of split-thickness skin graft around major joints in HCC (Hung-Chi Chen)-modified Charles’ procedure for advanced lymphedema

ObjectiveIn the conventional Charles' procedure for lower-limb lymphedema, full-thickness skin grafts (FTSGs) or flaps are the preferred treatment for areas around the knee and ankle because of the belief that FTSGs or flaps result in slighter contracture relative to split-thickness skin grafts (STSGs). However, the use of FTSGs or flaps prolongs operation and increases the risk of partial graft loss; should partial graft loss occur, additional grafting is required for remnant defects to avoid significant scarring after secondary healing. The senior author (HCC) thus modified the Charles' procedure and used STSGs around the knee and ankle. The aim of this study was to elucidate the long-term outcomes of STSGs in HCC-modified Charles’ procedure, including its attendant complications, such as joint contracture, range-of-motion limitations, and the presence of hypertrophic scars. MethodsParticipants were patients (n = 142) who underwent HCC-modified Charles’ procedure and STSGs between 1990 and 2016 for advanced lymphedema; the follow-up was at least 3 years. We detail our modification for improving the take of STSGs in the first operation and the rehabilitation protocol. ResultsThe active flexion of knee was >90° in 89.4% and 70°–90° in 10.6% of patients. The active plantar flexion of ankle was 30° in 90.8% and 20°–30° in 9.2% of patients. In Stiefel Grading System, 85.9% were “Excellent,” 12.0% were “Good,” 2.1% were “Fair,” and 0 were “Poor.” ConclusionSTSGs in HCC-modified Charles’ procedure yield satisfactory outcomes without joint contracture. Early physiotherapy and the primary take of STSGs are crucial to good functional outcomes.

The arrow tip technique for bilateral hanging ala: a 3-year review

Hanging ala is one of the alar-columellar discrepancies encountered in a rhinoplasty procedure among the Asian population. The principle of lifting both the ala effectively while keeping its symmetry remains a challenge. The arrow tip technique is designed to address the bilateral hanging ala which allows greater alar mobility and lifting effect, producing a desirable outcome of the overall nasal feature. This retrospective review is aimed to analyse the effectiveness of the proposed alar surgical technique and assesses the possible complications that require revision surgery. Fifteen Asian patients underwent the ‘arrow tip technique’ alar surgery in conjunction of a rhinoplasty procedure in a single-centre 3-year study for bilateral hanging ala. Pre- and post-operative clinical and photographic nasal analyses were performed for changes of alar vertical height on lateral and frontal views. On the frontal view, the mean percentage of alar shortening was 13.11%, 95%CI [11.46%, 14.76%]. On the lateral view, the mean percentage of alar shortening was 20.36%, 95%CI [19.01%, 21.71%]. The mean frontal-lateral alar shortening was − 7.25%, 95%CI [− 8.76%, − 5.74%]. Two patients required revision surgery for scars (13.3%) and another for nostril asymmetry (6%). This innovative technique is effective, safe and predictable in correcting the hanging ala. Understanding the relevance of performing an effective alar surgery through safe surgical landmarks, the use of full-thickness skin grafts and taking proper precautions can avoid the unnecessary fear of the complications of an external approach to an alar surgery such as scarring, bleeding, alar asymmetry and recurrence. Level of evidence: Level IV, therapeutic study.

Review of penile reconstructive techniques.

Reconstructive surgery of the penis holds many unique challenges due to the unique physiological properties of the tissues. Much of the effort involved therefore goes to preserving as much of the native tissue as possible whilst novel and creative methods have been adopted to repair defects and in creation of neophallus. A search of the PubMed database was carried out using the following keywords: 'penile trauma', 'penile cancer', 'lichen sclerosus', 'glansectomy', 'glans resurfacing', 'penile-sparing surgery', 'micropenis', 'aphallia', 'female-to-male sex reassignment surgery', 'scrotal flap' and 'genital lymphoedema'. Results for glans resurfacing in treating cancer showed low local recurrence rates at 0-10% whilst 90% of lichen sclerosus patients reported complete resolutions of pain and pruritis. For repairs of penile shaft skin defects the literature supports the use of full-thickness skin graft and pedicled scrotal flaps. The radial artery-based forearm free flap remains the best option for neophallus creation in terms of function, sensation and cosmesis but unfortunately leaves a disfiguring scar and involves multiple stages. Some novel techniques have been developed to circumvent these issues and are discussed. This article presents an update on the important developments in the field of penile reconstructive surgery.

Successful correction of pseudosyndactyly in recessive dystrophic epidermolysis bullosa with the use of full-thickness skin graft in resource-poor settings

Successful correction of pseudosyndactyly in recessive dystrophic epidermolysis bullosa with the use of full-thickness skin graft in resource-poor settings

Abstract 24: Comparison of full-thickness versus split-thickness skin graft reconstruction of scalp defects

Abstract Objective: To compare the surgical outcomes of patients who underwent full-thickness skin grafts (FTSG) versus split-thickness skin grafts (STSG) for the reconstruction of scalp defects. Background: A wide range of scalp defects may arise following oncologic resection of scalp malignancies and the reconstruction of such defects may be challenging for reconstructive surgeons. In larger surgical defects, skin grafts may be used to facilitate wound healing and decrease the complexity of wound care, especially when a lack of hair-bearing scalp is not a concern. The majority of literature on scalp reconstruction only describes the use of STSG and generally recommends it only on a well-vascularized wound bed with intact periosteum. There is also a general belief that FTSG have lower survival compared with STSG, although there are limited published data on the use of FTSG for scalp reconstruction or any data comparing the outcomes of these two methods in scalp reconstruction. This study seeks to provide the first objective comparison of surgical outcomes in FTSG versus STSG for the reconstruction of scalp defects. Methods: We performed a retrospective chart review of patients who underwent scalp reconstruction with skin grafts at a single-institution academic tertiary care center from 2011 and 2016. χ2 or Fisher exact tests were used to compare graft take and complication rates. The effects of graft type, defect type, graft size, and patient comorbidities on the likelihood of graft take and complications were analyzed using multivariate logistic regression. Results: 125 full-thickness and 93 split-thickness skin grafts were performed on 200 patients with scalp defects. FTSG required fewer average reconstructions compared with STSG (1.06 vs. 1.24, P = 0.002). 92.8% of FTSG had complete graft take compared to 78.5% of STSG (P = 0.002). This difference between complete graft take was more evident in defects with exposed calvarium (87.2% vs. 47.6%, P = <0.001). Despite higher rates of minor debridement, FTSG resulted in less postoperative bone exposure and wound breakdown compared to STSG on both intact pericranium and exposed calvarium defects. Preoperative radiation, immunosuppression and increased graft sizes were also significant predictors of graft outcomes. Conclusion: Skin grafts, especially full-thickness, provide a versatile, reliable and simple approach for reconstructing medium to large scalp defects in the appropriate patient. Even on defects with bare calvarium, FTSG can have excellent graft take when a vascularized recipient bed is prepared. Defects with exposed bone, larger graft sizes, preoperative radiation and immunosuppression may result in decreased graft take and increased complications. Citation Format: Xue Zhao, Scott Mclean. Comparison of full-thickness versus split-thickness skin graft reconstruction of scalp defects [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; April 23-25, 2017; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(23_Suppl):Abstract nr 24.

Penile Inversion Vaginoplasty with or without Additional Full-Thickness Skin Graft: To Graft or Not to Graft?

Penile inversion vaginoplasty is considered to be the gold standard for gender reassignment surgery in transgender women. The use of additional full-thickness skin graft as neovaginal lining is controversial. Some believe that having extra penile skin for the vulva gives better aesthetic results. Others believe that it gives inferior functional results because of insensitivity and skin graft contraction. Transgender women undergoing penile inversion vaginoplasty were studied prospectively. The option to add full-thickness skin graft is offered in patients where the penile skin length lies between 7 and 12 cm. Neovaginal depth was measured at surgery and during follow-up (3, 13, 26, and 52 weeks postoperatively). Satisfaction with the aesthetic result, neovaginal depth, and dilation regimen during follow-up were recorded. Satisfaction, sexual function, and genital self-image were assessed using questionnaires. A total of 100 patients were included (32 with and 68 without additional full-thickness skin graft). Patient-reported aesthetic outcome, overall satisfaction with the neovagina, sexual function, and genital self-image were not significantly associated with surgical technique. The mean intraoperative neovaginal depth was 13.8 ± 1.4 cm. After 1 year, this was 11.5 ± 2.5 cm. The largest decline (-15 percent) in depth is observed in the first 3 postoperative weeks (p < 0.01). The authors can confirm neither of the suggested arguments, for or against full-thickness skin graft use, in penile inversion vaginoplasty. The additional use of full-thickness skin graft does not influence neovaginal shrinkage, nor does it affect the patient- and physician-reported aesthetic or functional outcome. Therapeutic, IV.

Retroauricular full-thickness skin grafts in syndactyly repair: outcome and comparison with inguinal full-thickness skin grafts: retrospective (cross-sectional) study

Objective: Most surgeons recommend the use of full-thickness skin grafts for syndactyly repair. Common donor sites include the groin and elbow, but only one publication has previously mentioned retroauricular skin. No publication has compared the results for full-thickness skin grafts between retroauricular and other donor sites. This study aims at comparing functional and aesthetic outcomes and parents’ satisfaction with retroauricular vs inguinal full-thickness skin grafts. Methods: Eleven children with retroauricular and 15 with inguinal full-thickness skin grafts were included in this retrospective study. Examination included the Patient and Observer Scar Assessment Scale, parent satisfaction, and a colour match measurement. Results: Both pigmentation match and parents’ overall impression of the donor site were significantly better for retroauricular than for inguinal full-thickness skin grafts. Conclusion: Due to the excellent pigmentation match and the inconspicuousness of the donor site, this study recommends the use of retroauricular full-thickness skin grafts for syndactyly repair.

Full-thickness skin grafts for surgical defects of the nasal ala - a comprehensive review, approach and outcomes of 186 cases over 9 years

Skin cancers of the nasal ala are commonly encountered in dermatological surgery. Various techniques have been described to reconstruct surgical defects of the ala, including melolabial transposition flaps, interpolated melolabial flaps, bilobed and trilobed transposition flaps, island pedicle flaps and spiral flaps. Full-thickness skin grafts have received little attention in the reconstructive literature. We present our experience with full-thickness skin grafts for the reconstruction of partial thickness defects of the nasal ala in the largest series to date. A retrospective analysis of the Mohs micrographic surgery database over a 9-year period was performed. All cases of full-thickness skin grafts for reconstruction of the nasal ala were identified. Defect location, size and any postoperative complications were noted. All patients were reviewed at the time of suture removal, at 3 and 6weeks postoperatively and at 1year. There were 186 cases in total in 181 patients (88 men and 93 women). Their ages ranged from 31 to 88years with a mean of 65years (median 66). Defect size varied from 0·3×0·4cm to 2·0×2·7cm, with the average defect size measuring 1·0-1·2cm in diameter. Thirty-six per cent (67 of 186) of cases underwent postoperative dermabrasion, and 8% (14 of 186) received postoperative intralesional triamcinolone. The incidence of graft failure and infection was low. Good-to-excellent cosmetic results were seen in all patients and postoperative complications were uncommon and minor. The use of full-thickness skin grafts for defects of the nasal ala is a simple and versatile reconstructive option with excellent functional and aesthetic outcomes.

Long-term aesthetic outcome of fingertip reconstruction in complete syndactyly release

An aesthetically pleasing fingertip is an important but often under evaluated goal in syndactyly release. We assessed the aesthetic fingertip outcome in 26 patients with complete syndactylies, with a total of 84 separated digits, using a four-grade scale based on the quality of the lateral nail fold, nail plate definition, symmetry and pulp fullness. Fingertips with complete simple syndactylies released with the use of full-thickness skin grafts achieved a significantly better aesthetic result then fingertips with complete complex syndactylies released with the use of Buck-Gramcko pulp flaps. Fingertips involved in complex syndactylies achieved significantly better aesthetic results when reconstructed using Buck-Gramcko flaps in comparison with those reconstructed with full-thickness skin grafts. We recommend the use of Buck-Gramcko flaps in complete complex syndactylies, while reserve the traditional zig-zag and full-thickness skin graft closure for cases of complete simple syndactylies. We also propose a grading system for the aesthetic outcome of the fingertip following syndactyly release.

P131: Bone-Anchored Hearing Aid Abutment Skin Overgrowth Reduction

P131: Bone-Anchored Hearing Aid Abutment Skin Overgrowth Reduction

The "Drumhead" Graft Repair of Deep Nasal Alar Defects

Extirpation of tumors on the perialar region often results in deep surgical defects. The nares and internal nasal valves are supported not just by alar cartilage, but also by the suspension effect of the overlying skin and subcutaneous tissue. Surgical loss of tissue may result in inward collapse of the nasal vestibule with resultant difficulty in breathing. The use of full-thickness skin grafts (FTSGs) on deep alar defects commonly results in a sunken or depressed graft that is functionally and cosmetically unacceptable. We describe a novel technique that enables the use of FTSGs in the repair of deep nasal alar defects through the application of an overlying, rigid plastic suspension strut coupled with an undersized graft. The drumhead FTSG is effective in preventing collapse of the nasal vestibule as well as undesirable contour irregularities due to a depressed or sunken graft. Patients were seen at 1 week, 4 weeks, and 3 months postoperatively. At each time point, there was no nasal vestibular collapse and only very slight graft depression, which replicated the normal mild concavity of the alar crease region. All patients had excellent functional and cosmetic outcomes. No adverse effects were noted. The "drumhead" graft is a novel technique, which enables the use of FTSGs for deep alar defects by inhibiting undesirable depression of the graft and preventing collapse of the nasal vestibule.

The Beveled Edge Technique for Harvesting of Full-Thickness Skin Grafts

Background. Mohs surgery often uses the creation of a “beveled edge” of 45 degrees during the staged excision of skin cancers. Reconstruction of these defects frequently requires the use of full-thickness skin grafts. Because most wounds are best repaired with 90-degree edges, the beveled incision technique often used in Mohs micrographic surgery creates a wound that may need to be modified prior to reconstruction. Objective. We present a method of harvesting the graft with a similar 45-degree angle beveled incision. Methods. After marking, preparing, locally anesthetizing, and draping the donor site, the graft is harvested using a 45-degree angled incision. Any remaining fat is trimmed away from the base of the graft. The graft is then placed directly on the surgical defect without any “freshening” of the wound edges and is sutured into place. Results. The graft takes well on the surgically created defect, leaving a cosmetically acceptable result. Conclusion. We have found that harvesting the graft with a beveled incision of 45 degrees, similar to taking Mohs stages, hastens the repair process. This obviates the need to remove normal tissue to create a 90-degree angle and allows for better approximation of the dermal surface area of the graft to the base of the defect.

The Beveled Edge Technique for Harvesting of Full-Thickness Skin Grafts

Mohs surgery often uses the creation of a "beveled edge" of 45 degrees during the staged excision of skin cancers. Reconstruction of these defects frequently requires the use of full-thickness skin grafts. Because most wounds are best repaired with 90-degree edges, the beveled incision technique often used in Mohs micrographic surgery creates a wound that may need to be modified prior to reconstruction. We present a method of harvesting the graft with a similar 45-degree angle beveled incision. After marking, preparing, locally anesthetizing, and draping the donor site, the graft is harvested using a 45-degree angled incision. Any remaining fat is trimmed away from the base of the graft. The graft is then placed directly on the surgical defect without any "freshening" of the wound edges and is sutured into place. The graft takes well on the surgically created defect, leaving a cosmetically acceptable result. We have found that harvesting the graft with a beveled incision of 45 degrees, similar to taking Mohs stages, hastens the repair process. This obviates the need to remove normal tissue to create a 90-degree angle and allows for better approximation of the dermal surface area of the graft to the base of the defect.

The use of full-thickness skin grafts for the skin-abutment interface around bone-anchored hearing aids.

To review the complication rate encountered with the use of full-thickness skin grafts to establish the skin-abutment interface around bone-anchored hearing aid implants. Retrospective chart review. Tertiary referral center. Fifteen patients who underwent bone-anchored hearing aid placement over a 4-year period. Each percutaneous titanium implant and abutment was placed into the temporal bone following the standard Branemark technique. Eight procedures were performed in two stages, and seven were performed as single-stage procedures. In all cases, the skin-abutment interface was established by use of a full-thickness skin graft inset around the implant. The incidence of complications resulting in skin graft loss, time from implantation to bone-anchored hearing aid use, additional procedures for revision of the interface, and complicating medical factors in the patient population. Seven patients (46.7%) experienced loss of the full-thickness skin graft around the abutment. Four of these seven had complicating medical factors associated with impaired wound healing: two with diabetes mellitus, one of whom was also a smoker, and two patients who were receiving inhaled steroids for treatment of asthma. Of the seven patients who lost skin grafts, two healed by secondary intention, two underwent repeated full-thickness skin grafting, and three underwent galeal rotation flaps with split-thickness skin grafting, one of which eventually required a scalp flap. No patient experienced loss of the implant. The use of full-thickness skin grafts for establishment of the skin-abutment interface around bone-anchored hearing aid implants is associated with a high rate of graft loss. Although salvage techniques can successfully establish the interface after skin graft failure, alternative methods should be considered, especially in high-risk patients.

The Use of Full-Thickness Skin Grafts in Pediatric Burn Reconstruction

Journal Article The Use of Full-Thickness Skin Grafts in Pediatric Burn Reconstruction Get access G. Warden, MD, FACS, G. Warden, MD, FACS 1Shriners Hospitals for Children, Cincinnati, OH Search for other works by this author on: Oxford Academic Google Scholar K. Yakuboff, MD, FACS, K. Yakuboff, MD, FACS 1Shriners Hospitals for Children, Cincinnati, OH Search for other works by this author on: Oxford Academic Google Scholar R. Kagan, MD, FACS R. Kagan, MD, FACS 1Shriners Hospitals for Children, Cincinnati, OH Search for other works by this author on: Oxford Academic Google Scholar The Journal of Burn Care & Rehabilitation, Volume 24, Issue suppl_2, March-April 2003, Page S133, https://doi.org/10.1097/00004630-200303002-00181 Published: 01 March 2003

The Use of Full-Thickness Skin Grafts in the Management of Acute Pediatric Burns

The Use of Full-Thickness Skin Grafts in the Management of Acute Pediatric Burns

The use of full-thickness skin grafts to repair nonperforating nasal defects

The use of full-thickness skin grafts to repair nonperforating nasal defects