Use Of Split-thickness Grafts Research Articles

Surgical demographics of acute thigh compartment syndrome

BackgroundThe objective of this study was to identify demographic, injury-related, and treatment-related characteristics of patients who underwent decompressive fasciotomies for acute thigh compartment syndrome. MethodsA cohort of 38 adult patients with acute thigh compartment syndrome treated with fasciotomy at two tertiary care referral centers over a 10-year time period from January 1, 2006 to June 30, 2015 were retrospectively identified. We searched the electronic medical record for patient-related variables (e.g., age, sex, race, smoking status, diabetes mellitus), injury-related variables (e.g., mechanism of injury, associated fractures, other traumatic injuries), treatment-related variables (e.g., delay to treatment, compartments released, number of debridements, use of split-thickness grafts), and outcomes (e.g., amputation, death, sensory/motor impairments at final follow-up). ResultsThe mean age of our cohort was 47 years, and 35 patients (92%) were male. There were various mechanisms of injury, but the most common mechanisms were spontaneous hematoma (21%), followed by motor vehicle accidents (16%). Associated leg fractures were present in 15 (39%) patients. Delay between time of injury and fasciotomy was greater than 24 hours in 27 patients (71%), 12 to 24 hours in 6 patients (16%), and less than 6 hours in 3 patients (8%). The most frequently released compartment was the anterior compartment only (68%), followed by both the anterior and posterior compartments (16%) and the posterior compartment only (11%). Six patients (16%) had motor impairment, and 2 patients (5%) had sensory impairment at final follow-up. There were 2 deaths (5%) recorded in the hospital course for this cohort, none of which were directly related to compartment syndrome of the thigh. ConclusionDelays to fasciotomy are frequent in the treatment of acute thigh compartment syndrome. The demographics of acute thigh compartment syndrome demonstrate a strong male predominance. Treating providers should recognize spontaneous hematoma and motor vehicle accidents as the most common causes of acute thigh compartment syndrome.

Excision and Grafting to Treat Multiple Skin Cancers on the Dorsal Hands

Multiple skin cancers, a fairly common finding in renal transplant patients, can be difficult to manage. This article describes the use of split thickness grafts to resurface the back of the hands in nine kidney transplant patients. The total surface of the dorsal hand …

Use of split thickness grafts in the repair of excisions of the oropharynx, base of the tongue, and larynx

Skin grafts are an important component in immediate reconstruction after extensive resection in the head and neck region. Edgerton [I] has written extensively on their use in the area of the laryngopharynx, and others [2,3] have remarked on their effectiveness in lining the tonsillar area, palate, and tongue. Most of the patients we treat with Tesions in the higher clinical stages have received 6,000 r of cobalt radiation prior to operation. Originally, we were reluctant to use skin grafts in the radiated areas and attempted to draw the structures together for primary closure wherever possible. Patients with carcinoma of the maxilla were an exception to this rule. Part of the repair in these patients for years has been the immediate lining of the defect with a split thickness graft [4]. These grafts usually take well despite high doses of preoperative radiation. Encouraged by this, we began to use skin grafts to cover extensive areas of postradiation resection in the laryngopharynx and oropharynx.