Use Of Split-thickness Skin Grafts Research Articles

Nonmelanoma facial skin cancer: surgical planning for resection and reconstruction

Introduction The most effective treatment for nonmelanotic fascial skin cancer is surgical excision. Preoperative planning and a thorough grasp of reconstructive procedures, such as primary closure skin grafting, locoregional tissue flaps, remote tissue flaps, and free tissue transfer, are essential for the surgical therapy of these tumors. The choice of nonmelanoma skin cancer (NMSC) therapy is very specific to each patient and is influenced by the patient’s age, size, histologic subtype, and location of the disease. Treatment is to obliterate the lesion while maintaining normal tissue, function, and appearance. The ideas and methods of surgical excision and reconstruction of skin malignancies unique to the face were covered in this study. Patients and methods This study involved 98 patients of various ages and sexes. Of them, 89% had basal cell carcinoma and 11% had squamous cell carcinoma, both low-and high-risk tumors with varying sizes, locations, and histological subtypes. A safety margin of 3–5 mm is used for excision of low-risk malignancies and 5–10 mm for high-risk cancers. In 17 patients, skin grafts (split-thickness skin grafts and full-thickness skin grafts) are employed. 56 patients underwent local advancement, transposition, and rotational flaps; 15 patients underwent regional interpolation flaps; 6 patients sustained neck lymph node infiltration so they underwent cervical block dissection and distant pedicled flaps as latissimus dorsi muscle flaps; and 4 patients underwent cervical block dissection and free tissue transfer. Results Six patients experienced problems in the form of two partial graft and flap losses, two wound infections, and one scar retraction; however, with targeted care, they recovered well. Ninety-two percent of patients found the cosmetic outcomes satisfactory, and the functional outcome was good. Conclusion Wide excision and appropriate surgical reconstruction are ideal treatment modalities and may yield good aesthetic results or functional outcome, also the use of split-thickness skin grafts does not come as a first priority, where a lot of cases could have been treated with local flaps, as demonstrated in this consecutive series of treated patients. Treatment of NMSC on the face required a basic knowledge, presents a challenge to plastic surgeons, and is based on achieving the best oncological, functional, and cosmetic result. It is crucial to emphasize the need of patient education and appropriate tumor monitoring after NMSC therapy. A review of a big series of facial malignancy that may guide further studies cannot be understated.

Coverage for the vascular pedicle of a free fasciocutaneous flap using split thickness skin graft with auxiliary procedure to achieve a safe method with no impairment of vessels: a case series and literature review

BackgroundThe vascular pedicle of a free flap is the most critical structure that determines its viability. Most of the times it is covered with local skin flaps raised from the recipient site or with part of the free flap itself. However, there are conditions in which the vascular pedicle can be covered with skin graft. The purpose of the present study is to describe our experience in the use of split-thickness skin grafts (STSG) as an auxiliary procedure for pedicle coverage.MethodsAll patients who underwent microvascular fasciocutaneous free flap reconstruction at the Department of Plastic Surgery of China Medical University Hospital in Taichung from 1986 to 2021 were retrospectively evaluated. Patients who met all of the following criteria were eligible for the study: microvascular free flap reconstruction of any region of the body with a fasciocutaneous flap and cases where tension was detected during skin closure over the pedicle of the flap and STSG was applied as a cover.ResultsThere were 14 cases in this series treated from 1986 to 2021. Among them, 11 cases had no additional skin at the proximal end of the free flap, nor local flap at disposal in the recipient site to cover the vessels. In 3 other cases a vascular bridge flap was used for cross-leg flap transfer without possibility of tension free tubulization to protect the vessels. All reconstruction were successful.ConclusionsDuring microvascular transfer of free flaps, if no skin flap is available to cover the vascular pedicle, skin graft can be used to protect the vessels without compromising the circulation of the flap. Our results, in accordance with the literature, supports the safety of this technique when direct closure of the skin above and near the pedicle is not possible.Level of evidenceLevel IV, Therapeutic.

CEA graft take after combining with a modified MEEK procedure

Resourceful surgical planning for coverage of large burns has led to refinement of early innovative procedures including meshed split thickness skin grafts (STSG), MEEK procedure, and use of cultured epidermal autografts (CEAs). The use of STSG remains standard of care for burn wound coverage; however, manual expansion of STSG is limited due to shortcomings with expansion rates greater than 4:1. The MEEK micrografting method is a method of preparing skin grafts with a device instead of manually with an autograft mesher, allowing reliable expansion rates of autografts up to 9:1. Although the CEA indication for use includes both with and without STSG, use of meshed STSG placed under CEA has been reported to minimize shear forces and hasten graft take. The purpose of this study was to evaluate success of graft take in patients receiving MEEK and CEA for wound coverage in extensive burns at a single burn center experienced in the use of both MEEK and CEA. Data in 15 patients who received both MEEK and CEA for the treatment of large burns (mean total body surface area [TBSA] of 66%) demonstrated a high rate of successful engraftment (87%), and an overall 73% survival rate.

Fasciocutaneous Flap Perineal Closure with Testicular Thigh Pouch for Scrotal Defects: Surgical Technique and Initial Experience

To describe the surgical technique and evaluate the safety, feasibility, and preliminary outcomes of perineal closure with fasciocutaneous flaps as an alternative to scrotoplasty for large genital wounds. Cases of perineal closure with fasciocutaneous flaps and thigh pouch creation for patients having undergone scrotectomy from January 2015 until August 2022 were reviewed for operative details and surgical outcomes. Twenty patients were identified undergoing this procedure. Patients had a median age of 64 (Inter-quartile range [IQR] 58-70), body mass index of 34 (IQR 29-40) and Charlson comorbidity index of 5 (IQR 4-8). Median total wound area was 443 cm2 (IQR 225-600). Operative technique in all cases included testicular thigh pouch and fasciocutaneous flap creation for perineal closure; these flaps were raised from the thigh in 18 patients and abdominal wall in 8. This technique resulted in 100% closure rate of the perineum with 3 patients required abdominal split thickness skin grafting (STSG) to complete closure. Complication occurred in 3 patients (15%) with 1 wound infection and 2 episodes of bleeding. Forty percent of patients were discharged home. Median follow-up was 9 months with only 1 patient reporting pain related to thigh pouches and none desiring elective scrotoplasty. Despite large defects, perineal closure was completed in all patients with minimal use of STSG. Complication rates were comparable to other methods despite significant patient frailty and no patients desired staged scrotoplasty. This method of closure adds an option for the complex perineal reconstruction patient.

Analysis of real-world length of stay data and costs associated with use of autologous skin cell suspension for the treatment of small burns in U.S. centers.

Autologous skin cell suspension (ASCS) is a treatment for acute thermal burn injuries associated with significantly lower donor skin requirements than conventional split-thickness skin grafts (STSG). Projections using the BEACON model suggest that among patients with small burns (total body surface area [TBSA]<20%), use of ASCS±STSG leads to a shorter length of stay (LOS) in hospital and cost savings compared with use of STSG alone. This study evaluated whether data from real-world clinical practice corroborate these findings. Electronic medical record data were collected from January 2019 through August 2020 from 500 healthcare facilities in the United States. Adult patients receiving inpatient treatment with ASCS±STSG for small burns were identified and matched to patients receiving STSG using baseline characteristics. LOS was assumed to cost $7554/day and to account for 70% of overall costs. Mean LOS and costs were calculated for the ASCS±STSG and STSG cohorts. A total of 151 ASCS±STSG and 2243 STSG cases were identified; 63.0% of patients were male and the average age was 44.2 years. Sixty-three matches were made between cohorts. LOS was 18.5 days with ASCS±STSG and 20.6 days with STSG (difference: 2.1 days [10.2%]). This difference led to bed cost savings of $15,587.62 per ASCS±STSG patient. Overall cost savings with ASCS±STSG were $22,268.03 per patient. Analysis of real-world data shows that treatment of small burn injuries with ASCS±STSG provides reduced LOS and substantial cost savings compared with STSG, supporting the validity of the BEACON model projections.

Through a New Lens: Skin-Grafted Free Flaps and Objective Facial Skin Color Matching.

Background: Head and neck ablative surgery can impose aesthetic disfigurement, particularly when severe color mismatch exists between native and reconstructed facial skin. To date, the accuracy, objectivity, and modifiability of facial skin color matching remains poorly understood. Objective: To measure skin color match outcomes after head and neck reconstruction using handheld colorimetry. Methods: Patients undergoing complex head and neck reconstruction involving facial skin were included. A variety of skin paddle donor sites were studied, including split-thickness skin graft (STSG) placement over myocutaneous or adipofasciocutaneous free flaps after de-epithelization. Skin color match (deltaE) was measured during follow-up using a handheld colorimeter. Results: Forty-seven patients were included, with median age 69. The most common flap type was the anterolateral thigh (n = 31, 66%). Twenty patients underwent STSG to the skin paddle. DeltaE measurements among the patients with STSGs demonstrated better color match (lowest deltaE), compared with patients with unaltered skin paddles (3.4 ± 1.0 vs. 6.5 ± 2.5, p < 0.0001). Conclusion: We found the use of STSGs over de-epithelialized myogenous or adipofasciocutaneous flaps improves color match, as measured by handheld colorimetry.

MP02-03 FASCIOCUTANEOUS FLAP CLOSURE OF THE PERINEUM AS AN ALTERNATIVE TO SCROTOPLASTY FOR EXTENSIVE GENITAL TISSUE LOSS

You have accessJournal of UrologyCME1 Apr 2023MP02-03 FASCIOCUTANEOUS FLAP CLOSURE OF THE PERINEUM AS AN ALTERNATIVE TO SCROTOPLASTY FOR EXTENSIVE GENITAL TISSUE LOSS Christopher Staniorski, Robin Vasan, Michael Pintauro, Michelle Yu, and Paul Rusilko Christopher StaniorskiChristopher Staniorski More articles by this author , Robin VasanRobin Vasan More articles by this author , Michael PintauroMichael Pintauro More articles by this author , Michelle YuMichelle Yu More articles by this author , and Paul RusilkoPaul Rusilko More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Genital tissue loss is a surgical challenge often occurring in complex patients. Scrotoplasty with flaps and split thickness skin grafts (STSG) are two methods of closure but carry complication rates as high as 28% and may not be ideal for medically complex patients. However, closure by secondary intention is associated with wound care needs and patient discomfort. Our objective is to evaluate an alternative method of perineal closure in lieu of scrotoplasty in a complex population. METHODS: We retrospectively reviewed patient charts of adults who underwent perineal closure with fasciocutaneous flaps and thigh pouch creation. Our primary outcomes were complication rate and wound coverage. Secondary outcomes included measures of patient satisfaction and post-operative care needs. RESULTS: 20 patients were identified who underwent this closure, the majority following Fourniers gangrene. Patients had a median age of 64 (IQR 58 – 70), BMI of 34 (IQR 29 – 40) and Charlson comorbidity index of 5 (IQR 4 – 8) equating to a 21% 10-year survival. The median total wound dimension was 443 cm2 (IQR 225 – 600). Operative technique in all cases included testicular thigh pouch and fasciocutaneous flap creation from the thigh (n=18) or abdominal wall (n=8) and resulted in 100% closure rate of the perineum. Escutcheonectomy was used to increase the size of abdominal flaps in 2 patients with over 600 cm2 of skin loss. Only three patients required abdominal STSG to complete closure. Complication rate was 15% with 1 wound infection and 2 episodes of bleeding. Patients stayed a median of 7.5 days following closure (IQR 3-12.5) and 40% were discharged home. Median follow up was 9 months (n=16, IQR 3.25 – 14.75) with only 1 patient (6%) reporting pain related to thigh pouches and none desiring elective scrotoplasty. CONCLUSIONS: Despite large defects, this method of reconstruction allowed for perineal closure in all patients with minimal use of STSG. Despite significant medical comorbidity, complication rates were comparable to those previously reported and patients were largely satisfied with their reconstruction with none desiring formal scrotoplasty. While larger sample sizes are needed, this method of closure appears to add an option for the medically and surgically complex perineal reconstruction patient. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e11 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Staniorski More articles by this author Robin Vasan More articles by this author Michael Pintauro More articles by this author Michelle Yu More articles by this author Paul Rusilko More articles by this author Expand All Advertisement PDF downloadLoading ...

Long-term results of split-thickness skin grafting with and without additional dermal matrix in severe traumatic soft tissue defects of the lower limb.

Aim of this study was to compare the use of split-thickness skin graft (STSG) with and without additional MatriDerm® application in a predominantly one-step procedure for the treatment of severe traumatic soft tissue defects of the lower limb. This retrospective study included patients treated in a European level I trauma center between June 2013 and July 2018 in terms of a severe traumatic soft tissue defect of the lower extremity using STSG alone or in combination with the acellular dermal substitute MatriDerm®. The healing of the soft tissue defect was measured by assessment of the take rate. Outcome quality of the scar tissue was assessed using the Vancouver Scar Scale. A total of 147 cases were included in this study. The overall healing rate (number of patients with take rate ≥ 75%) was 88/147 (60%) and did not demonstrate significant differences between the treatment groups (p = 0.15). Despite the difference in wound complexity between the treatment groups, there was no difference regarding the scar tissue quality 12months postoperatively. In about 25% of all cases, a post-operative event was mentioned that had to be revised surgically. Surgical treatment with STSG and additional MatriDerm® application can be recommended as satisfactory alternative for dermis replacement in patients with severe skin defects, independent of age. The additional MatriDerm® use allows for bridging of exposed ligaments, tendons, vessels or bones without relevant differences in cosmetical outcome.

The Value of Negative-Pressure Wound Therapy and Flap Surgery in Hidradenitis Suppurativa - A Single Center Analysis of Different Treatment Options.

BackgroundHidradenitis suppurativa is manifested by painful abscesses and scarring of sweat glands. Axillary, inguinal and genital regions are mostly affected. Multiple options exist in the treatment of hidradenitis suppurativa. The aim of this retrospective, mono-center cohort study was to analyze the outcome of different treatment methods after radical excision of hidradenitis suppurativa.MethodsWe retrospectively evaluated the treatment strategy and recurrence rate of hidradenitis suppurativa. We included all eligible patients of legal age between February 2003 and October 2021, with the diagnosis of Hidradenitis suppurativa and the necessity for surgical treatment. All patients with surgical treatment and direct wound closure by suture were excluded. Bacterial load and flora were analyzed for primary and secondary reconstruction in combination with negative-pressure wound therapy. Patient data were analyzed for recurrence rate and remission time according to different reconstructive techniques.ResultsIn 44 affected anatomical sites (n = 23 patients) we treated 15 patients with negative-pressure wound therapy. Bacterial load and flora were lower in the last wound swab of patients with multi-surgical procedures (22 localizations) compared to the first wound swab independent of the use of negative-pressure wound therapy.Wound closure, independent of a direct and multi-stage procedure was achieved by local fasciocutaneous flaps (n = 12), secondary intention healing (n = 7), secondary intention healing with buried chip skin grafts (n = 10), or split-thickness skin grafts (n = 15). Radical excision combined with split-thickness skin grafts showed the lowest recurrence rate in the follow-up (16%; n = 4).ConclusionRadical excision of hidradenitis suppurativa as gold standard for surgical treatment combined with negative-pressure wound therapy as multi-stage procedures ultimately reduced bacterial load and flora in our study. The use of split-thickness skin grafts showed the lowest recurrence rate.

Long-term outcomes for 2-stage urethroplasty: an analysis of risk factors for urethral stricture recurrence

PurposeTo report long-term results and patient reported outcomes of staged anterior urethroplasties, and isolate risk factors for recurrence.Methods We reviewed urethroplasty database for all patients who underwent staged urethroplasty from 2000 to 2017. Follow-up included a cystoscopy 4 months after their 2nd stage to assess early success, and then annual follow-up thereafter with post-void residual and symptom assessment. Stricture characteristics, etiology and graft type were analyzed with regards to success.Results Forty-nine patients were eligible for inclusion. The median stricture length was 7 cm (3–17 cm). The early success rate demonstrated by cystoscopy at 4 months was 100%. Long-term success was 96.4% in buccal graft (BMG) only patients; however, long-term success fell considerably to 53% in patients requiring any use split thickness skin graft (STSG) in the first stage. Median follow up time was 57 months (6–240 months). On analysis, age, increased stricture length and especially the use of STSG all appeared to be associated with late recurrence. The recurrence group had longer stricture length and were more likely to be panurethral. All recurrences occurred after the initial 4-month cystoscopy with a median time to recurrence of 78 months.ConclusionStaged repairs that are amenable to BMG-only repairs have high long-term success rates. Increasing stricture length and the addition of split-thickness skin graft were associated with lower success rate in staged urethral reconstruction. Patients requiring staged repairs often experience recurrence in a very delayed fashion reinforcing the need for close, long-term follow up.

124 Autologous Skin Cell Suspension Achieves Closure of Donor Site Wounds Facilitating Early Re-harvesting for Large TBSA burn Injuries

Abstract Introduction Management of extensive burn injuries is complicated often resulting in significant morbidity and mortality. Current standard of care includes use of split-thickness skin grafts (STSG) to obtain definitive closure; however, this treatment is often limited by donor site availability, which requires repeated re-harvesting of donor sites to obtain definitive closure in large total body surface area injuries. Additionally, this limitation often leads to increased risk of infection, hypertrophic scarring, and extended hospital length of stay. Autologous skin cell suspension (ASCS) prepared using the autologous cell harvesting device is an FDA approved point-of-care regenerative medicine technology that significantly reduces donor skin requirements to achieve definitive closure in acute thermal burn injuries across small and large burns. A prospective uncontrolled observational study (IDE 15945—NCT02992249) was conducted in which patients with life-threatening burn injuries were treated with ASCS. In this study, clinical outcomes were evaluated when ASCS was used in combination with wide meshed autografts for burn site treatment. Within the study, a subset of donor sites was also treated with ASCS and the purpose of the current work was to evaluate the clinical outcomes obtained to better understand impact on healing times and effect of re-harvesting in this compromised patient population. Methods ASCS was applied to the donor site after harvesting of split-thickness skin grafts. Clinical outcomes out to one year were evaluated, including the percentage of re-epithelialization, long-term cosmetic outcomes, and adverse events. Results Subjects (n=96) from 22 burn centers received ASCS as part of their donor site treatment regimen (n=528). Mean subject baseline demographics were: 30.2 years of age, 54.0 ± 17.4% TBSA injury, and 89.4 ± 32.9 Baux score with 37% of subjects having a score greater than 100. Percentage of donor sites healed, defined as &amp;gt;95% re-epithelialization, was 37.1% and 82.7% after week 1 and week 2, respectively. Approximately 20% of the donor sites treated with ASCS were re-harvested multiple times following initial healing (up to four times). Of these donor sites 39.3% (n=84), 81.0% (n=79), and 85.7% (n=77) were healed by week 1, week 2, and week 4, respectively. Scar assessments conducted on 427 donor sites after one year showed the majority had matched or mildly mismatched color, pigment, and texture. Safety analyses of adverse events (AEs) following ASCS treatment were unlikely or unrelated to the device. Conclusions This study demonstrates successful use of ASCS to achieve closure of donor site wounds in patients with extensive burn injuries.

Split-thickness skin graft donor-site morbidity: A systematic literature review

The purpose of this systematic literature review is to critically evaluate split-thickness skin graft (STSG) donor-site morbidities. The search of peer-reviewed articles in three databases from January 2009 to July 2019 identified 4271 English-language publications reporting STSG donor-site clinical outcomes, complications, or quality of life. Of these studies, 77 met inclusion criteria for analysis. Mean time to donor-site epithelialization ranged from 4.7 to 35.0 days. Mean pain scores (0–10 scale) ranged from 1.24 to 6.38 on postoperative Day 3. Mean scar scores (0–13 scale) ranged from 0 to 10.9 at Year 1. One study reported 28% of patients had donor-site scar hypertrophy at 8 years. Infection rates were generally low but ranged from 0 to 56%. Less frequently reported outcomes included pruritus, wound exudation, and esthetic dissatisfaction. Donor-site wounds underwent days of wound care and were frequently associated with pain and scarring. Widespread variations were noted in STSG donor-site outcomes likely due to inconsistencies in the definition of outcomes and utilization of various assessment tools. Understanding the true burden of donor sites may drive innovative treatments that would reduce the use of STSGs and address the associated morbidities.

498 Healing of Donor Sites with an Autologous Skin Cell Suspension for Large TBSA Burn Injuries: A Prospective Evaluation

Current treatment for burn injuries is the use of split-thickness skin grafts (STSG), however this treatment is often limited by donor site availability and requires reharvesting of donor sites to obtain definitive closure. In uncompromised patients it can take 7-14 days to heal, and for patients with severe injuries, this time can be delayed. The RECELL® System is a point-of-care device that allows for the preparation and application of non-cultured, autologous skin cells; however the safety and effectiveness has not been established for use in the treatment of donor sites. This study presents the use of autologous skin cell suspension (ASCS), prepared using the RECELL® System for the treatment of donor sites in patients enrolled in a prospective uncontrolled observational study (IDE 15945—NCT02992249) with life-threatening burn injuries. Following harvesting of STSGs, ASCS was applied to the donor site. Clinical outcomes were evaluated up to one year including percentage of re-epithelialization, long-term cosmetic outcomes, and adverse events. Seventy-three patients from 15 burn centers had their donor sites treated with ASCS as part of their treatment regimen. The average subject age was 29 and the average TBSA injury was 54.1 ±16.5%. The mean Baux score was 84.3 with 32% of subjects having a score greater than 100. Collectively, 430 donor sites were individually treated. In this compromised patient population 45.5% were ≥95% re-epithelialized by week 1 (n=345), and by week 2, 91% of the donor sites were ≥95% re-epithelialized (n=277), regardless of times harvested. Approximately 20% of the donor sites treated with ACSC were reharvested multiple times following initial healing (3.5% three times, and two donor sites were harvested four times) and retreated. Of donor sites harvested more than once, 51.6% (n=62), 84.6% (n=66), and 96.4% (n=55) of sites were ≥ 95% re-epithelialized by week 1, 2 and 4, respectively. One-year data was available for 300 donor sites and the majority had matched or mildly mismatched color, pigment, and texture. Adverse events included one site with a hematoma and one patient with donor sites that had fragile skin loss secondary to traumatic friction. There were no other instances of infection or delayed healing. ASCS has been successfully used to achieve closure of donor site wounds without infection or delayed healing in patients with extensive burn injuries. Application of ASCS for donor site healing may be particularly applicable for patients requiring subsequent reharvesting to achieve definitive closure.

Acute compartment syndrome in patients undergoing fasciotomy of the forearm and the leg

The primary objective of this study is to compare the likelihood of acute compartment syndrome in the leg versus the forearm in patients who undergo fasciotomy for a clinical diagnosis of suspected acute compartment syndrome. The secondary objective is to identify factors associated with higher likelihood of acute compartment syndrome or with the use of split-thickness skin graft in these patients. We identified 449 patients diagnosed with suspected acute compartment syndrome of 468 legs and 119 patients diagnosed with suspected acute compartment syndrome of 119 forearms, treated with fasciotomy, from January 2000 to June 2015. Patients clinically diagnosed with suspected acute compartment syndrome were scored for likelihood of acute compartment syndrome based on muscle appearance, time to closure, neurologic deficit at final follow-up, and contracture at final follow-up. There was no difference in likelihood of acute compartment syndrome between the leg and the forearm, with about 70% having relatively high likelihood. Forearm fasciotomy was associated with documentation of poorer muscle appearance (p = 0.01) and contracture (p < 0.001) compared with leg fasciotomy. Multivariable logistic regression analyses showed that compartment pressure measurement (p = 0.01) was associated with higher likelihood of acute compartment syndrome in legs and that male sex (p = 0.001) and non-vascular mechanism of injury (p = 0.02) were associated with split-thickness skin graft in legs. The likelihood and severity of acute compartment syndrome are comparable in the leg and the forearm.

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 = &amp;lt;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.

Skin Grafts for Residual Limb Coverage and Preservation of Amputation Length

Split-thickness skin grafts have historically been used sparingly for amputation coverage when delayed primary closure is not feasible without substantial loss of length. The authors investigated the use of split-thickness skin grafts in the residual limbs of combat-related amputees. A retrospective review was completed on consecutive amputations of 300 lower and 100 upper extremities treated at Walter Reed National Military Medical Center from 2003 to 2009, comparing patients treated with split-thickness skin grafts with those treated with delayed primary closure. Principal outcomes measured included early (wound failure) and late (heterotopic ossification requiring excision and soft-tissue revisions) complications requiring surgery. Statically significant differences were seen, with the split-thickness skin graft group having an increased incidence of wound failure (p < 0.022), heterotopic ossification requiring excision (p < 0.001), and soft-tissue revisions (p < 0.001) compared with controls. The risk of revision was higher for lower extremity than for upper extremity amputations undergoing skin grafting. However, amputation level salvage, maintaining the proximal joint, was successful for all residual limbs with split-thickness skin grafts. Split-thickness skin grafts for closure of amputations result in significantly increased reoperation rates, but they are ultimately successful in salvaging residual limb length and amputation levels. In carefully selected patients, they may be a successful means of achieving definitive coverage when performed over robust, healthy muscle. In many patients, however, they should be viewed as a staging procedure to maintain length and amputation level until swelling decreases and revision surgery for split-thickness skin graft excision with or without concurrent procedures can be performed without the need to substantially shorten the residual limb.

Use of an acellular dermal template for defect coverage on the penile shaft

Skin defects of the penile shaft, caused by trauma, infection, or iatrogenically after surgery are commonly treated with skin grafts. A suboptimal postoperative outcome after the use of skin grafts is affected by the trend towards wound bed and skin graft contraction in this often-expanding region. We report on our experience using a new technique for defect coverage of the penile shaft with respect to its elasticity demands during erection and its mechanical demands during sexual intercourse. Furthermore we would like to illustrate the advantages of the application of a dermal substitute together with split-thickness skin grafts compared to the use of split-thickness skin grafts alone. At the follow-up, the patient did not report any impairment during erection or after sexual intercourse. The aesthetic outcome was natural and pleasing. The use of acellular dermal templates together with unmeshed split-thickness skin grafts has proven its superior functional and aesthetic outcome in several demanding regions. With the aid of negative-pressure wound therapy, a single procedure for penile defect coverage is possible. Our reported procedure revealed a natural and pleasing outcome, with no sexual impairment and high patient satisfaction. Level of Evidence: Level V, therapeutic study

Early Use of Split-thickness Skin Graft Allows Separation of the Wound into Different Compartments Facilitating the Collection of Enteroatmospheric Fistulae Output

Early Use of Split-thickness Skin Graft Allows Separation of the Wound into Different Compartments Facilitating the Collection of Enteroatmospheric Fistulae Output

AlloDerm with Split‐Thickness Skin Graft for Coverage of the Forearm Free Flap Donor Site

Major causes of donor site morbidity after free flap harvest are lack of split-thickness skin graft (STSG) take and tendon exposure. Long-term cosmesis remains poor. AlloDerm has shown cosmetically better donor site healing, albeit prolonged healing. We sought to evaluate the use of STSG with AlloDerm compared with STSG alone. Case series with chart review. Academic tertiary care medical center. Institutional review board-approved study. Microvascular database queried from 2002 to 2012. Subjects with forearm free flaps and either AlloDerm + STSG or STSG alone for donor site reconstruction were included. Morbidity outcomes were compared. Eighty patients (50 male, 30 female) received AlloDerm + STSG at the donor site. Major and minor donor site complications were 15.0% and 18.8% in the AlloDerm + STSG group compared with 10.2% and 16.9% in the STSG-only group (P = .30 and P = .72), respectively. Complete STSG loss (5.0% vs 3.0%, P = .48), tendon exposure (5.0% vs 5.4%, P = 1.0), functional impairment (2.5% vs 1.8%, P = .66), infection (8.8% vs 9.6%, P = 1.0), hematoma/seroma (5.0% vs 3.6%, P = .73), and paresthesia (1.3% vs 3.6%, P = .43) were not significant. No patients required a second STSG after loss in the AlloDerm + STSG group compared with 60% (P = .17). Cosmetic results were superior in the AlloDerm + STSG group as rated by the surgeon (3.5 vs 2.6, P = .03) and patients (3.7 vs 2.9, P = .05) on a scale of 1 to 5. Our results suggest that the use of AlloDerm with STSG can provide thicker coverage of the forearm defect, with minimal donor site morbidity and superior cosmetic results compared with STSG alone.

AlloDerm with Split‐Thickness Skin Graft for Coverage of the Forearm Free Flap Donor Site

Objectives: A major cause of forearm donor site morbidity after free flap harvest is lack of split-thickness skin graft (STSG) take. AlloDerm alone has been shown to allow healing of the donor site, albeit prolonged healing. We sought to evaluate the use of STSG with AlloDerm as compared to STSG alone. Methods: Patientswho underwent fasciocutaneous free flap harvest and had composite grafting at the donor site using AlloDerm+STSG were identified at an academic medical center from 2011-2012. 166 patients with a STSG alone acted as a control group. Morbidity data and aesthetic results were collected. Results: Eighty patients (50M, 30F) received AlloDerm+STSG. Overall donor site morbidity in the AlloDerm+STSG group was 27.5%, compared to 23.5% in the STSG only group, P = 0.53. Complete STSG loss (5% vs. 3%, P = 0.48), tendon exposure (5% vs. 5.4%, P = 1.0), functional impairment (2.5% vs. 1.8%, P = 0.66), infection (8.8% vs. 9.6%, P = 1.0), hematoma/seroma (5% vs. 3.6%, P = 0.73), and paresthesia (1.3% vs. 3.6%, P = 0.43) were not significant. No patients in the AlloDerm+STSG group required a second STSG after complete loss compared to 3 of 5 patients in the STSG only group, P = 0.17. Aesthetic results were superior in the AlloDerm+STSG group as rated by the surgeon (3.5 vs. 2.6, P = 0.03) and patients (3.7 vs. 2.9, P = 0.05) on a scale of 1-5. Conclusions: Our results suggest that AlloDerm with STSG can provide thicker coverage of the forearm defect after fasciocutaneous free flap harvest and superior cosmetic results. There is no significant difference in other associated morbidity.