RESUMEN
OBJECTIVE: Compare full-thickness skin grafts versus split-thickness skin grafts in scalp reconstruction. STUDY DESIGN: Retrospective chart review of patients who underwent scalp reconstruction with skin grafts performed at a single institution from 2011 to 2016. METHODS: χ2 or Fisher exact tests were used to compare graft integration and complication rates. The effects of graft type, defect type, graft size, and patient comorbidities on the likelihood of graft success and complications were analyzed using multivariate logistic regression. RESULTS: A hundred and twenty-five full-thickness and 93 split-thickness grafts were performed in 200 patients, including 68 defects (31.2%) with exposed calvarium. Full-thickness grafts required fewer average reconstructions (P = 0.002). A 92.8% of full-thickness grafts had complete graft integration compared with 78.5% of split-thickness grafts (P = 0.002). This difference was more evident in defects with exposed calvarium (87.2% vs. 47.6%, P ≤ 0.001). Despite higher rates of minor debridement, full-thickness grafts had less postoperative bone exposure and wound breakdown than split-thickness grafts on intact pericranium and exposed calvarium defects. Preoperative radiation, immunosuppression, and increased graft sizes were significant predictors of graft outcomes. CONCLUSIONS: 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, full-thickness grafts can succeed 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. LEVEL OF EVIDENCE: 3b.
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Procedimientos de Cirugía Plástica , Cuero Cabelludo , Trasplante de Piel , Cráneo , Humanos , Cuero Cabelludo/cirugía , Trasplante de Piel/métodos , Trasplante de Piel/efectos adversos , Masculino , Estudios Retrospectivos , Femenino , Anciano , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Cráneo/cirugía , Cráneo/trasplante , Adulto , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiología , Supervivencia de Injerto , Anciano de 80 o más AñosRESUMEN
BACKGROUND: The split-thickness skin graft (STSG) procedure is frequently used in the reconstruction of burn-injured patients. This study assessed the impact of graft timing on associated skin complications in patients with torso burns using a comprehensive national database. METHODS: Truncal burn (2nd-degree and 3rd-degree burns covering 20-89% TBSA) patients who underwent STSG in the National Trauma Data Bank from 2011 to 2015 were studied. The outcomes examined were graft-related complications (superficial surgical site infections, deep surgical site infections, and graft failure), overall mortality and hospital length of stay (LOS). Patients were compared based on the presence or absence of grafting complications. A linear regression model was used to assess the relationship between hospital LOS and graft timing, considering other variables. RESULTS: Among the 853 studied patients, the cohort with graft complications exhibited a significantly prolonged time to STSG (413.0 h compared to 264.6 h, P<0.001) and a higher percentage of patients with pre-existing diabetes (18.5 vs. 8.0%, P=0.008). The multiple logistic regression analysis revealed that both the extended time to STSG (odds=1.001, P=0.003) and pre-existing diabetes (odds=2.790, P=0.010) significantly elevated the likelihood of complications associated with STSG. Notably, this delay did not elevate mortality risks. A positive relationship was found between grafting delay and LOS. CONCLUSION: The findings underscore that a prolonged duration to skin grafting contributes to extended hospital stays and increased graft-related complications. However, the role of grafting delay in influencing the mortality of truncal burn patients appeared inconsequential, indicating that mortality may be influenced by various factors.
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Quemaduras , Tiempo de Internación , Trasplante de Piel , Humanos , Quemaduras/cirugía , Quemaduras/mortalidad , Trasplante de Piel/métodos , Trasplante de Piel/efectos adversos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Tiempo de Internación/estadística & datos numéricos , Bases de Datos Factuales , Estudios de Cohortes , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Adulto Joven , Factores de Tiempo , Anciano , Torso/cirugía , Torso/lesionesRESUMEN
OBJECTIVES: Dermal substitutes are classically used in a 2-stage procedure followed by skin graft for wound healing. This study aims to evaluate the possibility to use an alternative technique for radial forearm and fibula donor sites coverage using one-stage Pelnac reconstruction. MATERIALS AND METHODS: 21 patients who underwent radial forearm and fibula flaps harvest for reconstruction of head and neck defects after oncological surgery were enroled in the study. 13 patients were treated by one-stage Pelnac reconstruction of the donor site defect, 8 patients underwent full thickness skin graft. The Vancouver Scar Scale was used to evaluate the scar quality. RESULTS: Most patients treated with one-stage Pelnac reconstruction showed good healing of the flap donor site, with minor complications, scar quality comparable to other treatment options and unimpaired function of the implicated limb. One patient had wound dehiscence at the radial forearm site, which was treated with secondary full thickness skin graft. In the group treated with FTSG we had three patients that developed complications, such as dehiscence of the graft and seroma. Overall, we reported comparable satisfaction with donor sites both for aesthetic and functional outcomes, in both groups of patients. CONCLUSION: The use of Pelnac without a following skin graft provides a viable method for the reconstruction of radial forearm and fibula flaps donor site. A longer postoperative care is needed, but the long-term aesthetic and functional results are satisfactory in comparison with full thickness skin graft.
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Peroné , Antebrazo , Procedimientos de Cirugía Plástica , Trasplante de Piel , Sitio Donante de Trasplante , Cicatrización de Heridas , Humanos , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Peroné/trasplante , Peroné/cirugía , Trasplante de Piel/métodos , Trasplante de Piel/efectos adversos , Antebrazo/cirugía , Cicatrización de Heridas/fisiología , Procedimientos de Cirugía Plástica/métodos , Anciano , Sitio Donante de Trasplante/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Adulto , Resultado del Tratamiento , Colgajos Quirúrgicos/trasplanteRESUMEN
Invasive graft biopsies assess the efficacy of immunosuppression through lagging indicators of transplant rejection. We report on a microporous scaffold implant as a minimally invasive immunological niche to assay rejection before graft injury. Adoptive transfer of T cells into Rag2-/- mice with mismatched allografts induced acute cellular allograft rejection (ACAR), with subsequent validation in wild-type animals. Following murine heart or skin transplantation, scaffold implants accumulate predominantly innate immune cells. The scaffold enables frequent biopsy, and gene expression analyses identified biomarkers of ACAR before clinical signs of graft injury. This gene signature distinguishes ACAR and immunodeficient respiratory infection before injury onset, indicating the specificity of the biomarkers to differentiate ACAR from other inflammatory insult. Overall, this implantable scaffold enables remote evaluation of the early risk of rejection, which could potentially be used to reduce the frequency of routine graft biopsy, reduce toxicities by personalizing immunosuppression, and prolong transplant life.
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Aloinjertos , Biomarcadores , Rechazo de Injerto , Animales , Rechazo de Injerto/inmunología , Ratones , Trasplante de Piel/efectos adversos , Trasplante de Corazón/efectos adversos , Ingeniería de Tejidos/métodos , Andamios del Tejido/química , Tejido Subcutáneo/patología , Ratones Endogámicos C57BL , Ratones Noqueados , Linfocitos T/inmunología , Linfocitos T/metabolismoRESUMEN
BACKGROUND: Vitiligo treatment is challenging, especially for resistant and stable vitiligo, which requires surgical management. Noncultured epidermal cell suspension has been modified to enhance the treatment outcomes. OBJECTIVE: Comparison of autologous noncultured trypsinized epidermal cell suspension in recipient site prepared by cryoblebbling and noncultured nontrypsinized epidermal cell graft homogenized with plasma gel in recipient site prepared by dermabrasion for stable vitiligo treatment. MATERIALS AND METHODS: Interventional comparative study on 30 patients with stable vitiligo, randomly divided into 2 equal groups. Group A: noncultured trypsinized epidermal cell suspension for recipient prepared by cryoblebbling. Group B: noncultured nontrypsinized epidermal cell graft homogenized with plasma gel for recipient prepared by dermabrasion. Afterward, both groups received 3 months of narrow-band ultraviolet B phototherapy. RESULTS: The plasma gel group showed a significantly earlier onset of repigmentation and faster healing ( p = .002* and <.001*, respectively). Overall, repigmentation was higher in the plasma gel group ( p = .037* at the end of the second month). Color matching and patient satisfaction were higher in the plasma gel group, without statistical significance. The cryobleb group showed more recipient site complications, and the plasma gel procedure was relatively easier and cheaper. CONCLUSION: Plasma gel modification is cost-effective, less time-consuming, does not require trypsinization, and provides rapid, satisfactory, and uniform repigmentation. Cryoblebbing and trypsinization are effective; however, there are more technical difficulties, delayed healing, and delayed onset of repigmentation.
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Dermabrasión , Células Epidérmicas , Vitíligo , Humanos , Vitíligo/terapia , Masculino , Femenino , Adulto , Dermabrasión/métodos , Células Epidérmicas/trasplante , Trasplante Autólogo , Adulto Joven , Adolescente , Geles , Resultado del Tratamiento , Trasplante de Piel/métodos , Trasplante de Piel/efectos adversos , Satisfacción del Paciente , Persona de Mediana Edad , Criocirugía/métodos , Criocirugía/efectos adversosRESUMEN
BACKGROUND AND OBJECTIVE: Large defects of the nose after Mohs surgery pose a significant reconstructive challenge to both dermatologic and reconstructive surgeons. The authors present their 12-year experience utilizing acellular dermal matrices for nasal reconstruction. METHODS: A retrospective review of patients undergoing Mohs surgery and alloplastic nasal reconstruction with acellular dermal matrices between 2010 and 2022 was performed. Patients who underwent single-stage reconstruction and dual-stage reconstruction with skin graft with at least 90 days of follow-up were included. RESULTS: Fifty-one patients met criteria with a median age of 77 years. Fifty-three lesions were reconstructed with acellular dermal matrices. The most common lesion location was nasal sidewall (50%) with a mean defect size of 10.8 cm 2 . 30.8% underwent same-day acellular dermal matrix reconstruction, with 69.2% undergoing two-stage reconstruction. Acellular dermal matrices successfully reconstructed acquired defects in 94.2% of lesions. Average time to re-epithelialization was 27.6 + 6.2 days. Average time to repigmentation was 145.35 + 86 days. No recurrences were recorded. Total complication rate was 9.62%. Average size for successful healing was 10.8 cm 2 . Average defect size for complication or failure was 14.7 cm 2 . Seven sites (13.46%) underwent aesthetic improvement procedures. CONCLUSION: Acellular bilayer wound matrix is an adequate reconstructive option for single or dual-stage reconstruction of the nose with low complication and revision rates.
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Dermis Acelular , Cirugía de Mohs , Neoplasias Nasales , Neoplasias Cutáneas , Humanos , Cirugía de Mohs/efectos adversos , Estudios Retrospectivos , Anciano , Masculino , Femenino , Neoplasias Nasales/cirugía , Neoplasias Cutáneas/cirugía , Anciano de 80 o más Años , Persona de Mediana Edad , Rinoplastia/métodos , Rinoplastia/efectos adversos , Trasplante de Piel/métodos , Trasplante de Piel/efectos adversosRESUMEN
IMPORTANCE: Functional and cosmetic outcomes following Mohs micrographic surgery (MMS) are poorly studied in individuals with skin of color (SOC). Postinflammatory hyperpigmentation (PIH) may be long-lasting and highly distressing. SOC individuals are particularly susceptible to PIH following procedures. Objective: To characterize factors that contribute to the development of PIH following MMS in SOC. DESIGN: This retrospective study included 72 SOC individuals with 83 cases of keratinocyte carcinoma treated with MMS between August 2020 and August 2021 at a single medical center in the Bronx, New York. RESULTS: Postinflammatory hyperpigmentation following Mohs micrographic surgery was more common in Fitzpatrick skin types (FST) IV to V (48.0%) compared to FST I to III (18.2%; P=0.006). Grafts and granulation resulted in higher rates of PIH compared to linear repairs and flaps (87.5% vs 30.7%; P=0.003). Cases with postoperative complications resulted in higher rates of PIH compared to cases without (81.8% vs 29.2%; P=0.001). In a subset analysis of linear repairs, polyglactin 910 as a subcutaneous suture produced a higher rate of PIH compared to poliglecaprone 25 (46.2% vs 7.1%; P=0.015). Conclusions and Relevance: Individuals with SOC (FST IV to V) are more likely to develop PIH following MMS. Grafts and granulation lead to PIH more often than linear repairs and flaps. Postoperative complications significantly increase the risk of PIH. Surgeons should consider these risk factors during surgical planning in an effort to mitigate PIH in SOC individuals. Studies with larger sample sizes are indicated. J Drugs Dermatol. 2024;23(5):316-321. doi:10.36849/JDD.8146.
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Hiperpigmentación , Cirugía de Mohs , Complicaciones Posoperatorias , Neoplasias Cutáneas , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Carcinoma de Células Escamosas/cirugía , Tejido de Granulación/patología , Hiperpigmentación/etiología , Hiperpigmentación/epidemiología , Hiperpigmentación/diagnóstico , Cirugía de Mohs/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Estudios Retrospectivos , Neoplasias Cutáneas/cirugía , Trasplante de Piel/efectos adversos , Trasplante de Piel/métodos , Colgajos Quirúrgicos/efectos adversos , Pigmentación de la Piel , Minorías Étnicas y RacialesRESUMEN
Scars commonly give rise to unpredictable, potentially irritating, cutaneous complications including pruritis, folliculitis, and pigment changes. These problems can be self-limiting and are prevalent in many burn cases, although their expression varies among individuals. A better understanding of the presentation, risk factors, and pathophysiology of these long-term sequelae allows for more comprehensive care of burn survivors.
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Quemaduras , Trasplante de Piel , Humanos , Quemaduras/cirugía , Quemaduras/complicaciones , Quemaduras/terapia , Cicatriz/etiología , Cicatriz/cirugía , Foliculitis/etiología , Foliculitis/terapia , Trastornos de la Pigmentación/etiología , Trastornos de la Pigmentación/terapia , Trastornos de la Pigmentación/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Prurito/etiología , Prurito/terapia , Trasplante de Piel/efectos adversos , Trasplante de Piel/métodosRESUMEN
INTRODUCTION: Burn neck contractures pose a great challenge for reconstructive surgeons. A paucity of literature exist regarding long-term outcomes based on different surgical management strategies. The aim of this study was to evaluate the long-term outcomes of the treatment of neck burn scar contractures and evaluate surgical strategies according to their long-term effectiveness and associated complications. METHODS: A retrospective cohort study was conducted to review outcomes of neck contractures release after burn injury. All patients operated on between January 2009 and February 2023 at a single institution were included. RESULTS: A total of 20 patients developed neck burn scar contracture and were included in this study. The mean age was 32.9 ± 20.3 years. The burn injuries were most commonly thermal (n = 19, 95%). All burn injuries were full-thickness burns, with an average neck defect size of 130.5 ± 106.0 cm2. Overall, 45 surgical scar release procedures were performed on the 20 patients who developed a neck contracture. Patients underwent 1.65 ± 1.04 surgeries on average to address neck contracture. Although 25% of patients only received 1 surgery to treat neck contracture, some patients underwent as many as 8 surgeries. Contracture recurrence (CR) was the most common complication and occurred in 28.9% of the cases. The mean percentage total body surface area did not significantly differ in CR patients (26.7% ± 14.9%) and no-CR patients (44.5% ± 30.2%). However, there was a significant difference (P = 0.01) in the average neck defect size between CR patients (198.5 ± 108.3 cm2) and no-CR patients (81.1 ± 75.1 cm2). CONCLUSIONS: This study showed that risk factors for initial burn scar contractures may differ from those associated with CR, highlighting the importance of neck defect size as a predictor. The study also examines various surgical approaches, with Z-plasty showing promise for managing CR. However, the absence of data on neck range of motion is a limitation. This research underscores the complexity of managing CR and emphasizes the need for ongoing postoperative monitoring.
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Quemaduras , Contractura , Procedimientos de Cirugía Plástica , Tortícolis , Humanos , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Estudios Retrospectivos , Cicatriz/cirugía , Cicatriz/complicaciones , Contractura/etiología , Contractura/cirugía , Quemaduras/complicaciones , Quemaduras/cirugía , Trasplante de Piel/efectos adversosRESUMEN
BACKGROUND: Burn-related injuries are a major global health issue, causing 180,000 deaths per year. Early debridement of necrotic tissue in association with a split-thickness skin graft is usually administered for some of the 2nd- and 3rd-degree injuries. However, this approach can be complicated by factors such as a lack of proper donor sites. Artificial skin substitutes have attracted much attention for burn-related injuries. Keratinocyte sheets are one of the skin substitutes that their safety and efficacy have been reported by previous studies. METHODS: Two consecutive clinical trials were designed, one of them is phase I, a non-randomized, open-label trial with 5 patients, and phase II is a randomized and open-label trial with 35 patients. A total number of 40 patients diagnosed with 2nd-degree burn injury will receive allogenic keratinocyte sheet transplantation. The safety and efficacy of allogeneic skin graft with autograft skin transplantation and conventional treatments, including Vaseline dressing and topical antibiotic, will be compared in different wounds of a single patient in phase II. After the transplantation, patients will be followed up on days 3, 7, 10, 14, 21, and 28. In the 3rd and 6th months after the transplantation scar, a wound closure assessment will be conducted based on the Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale. DISCUSSION: This study will explain the design and rationale of a cellular-based skin substitute for the first time in Iran. In addition, this work proposes this product being registered as an off-the-shelf product for burn wound management in the country. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT) IRCT20080728001031N31, 2022-04-23 for phase I and IRCT20080728001031N36, 2024-03-15 for phase II.
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Quemaduras , Trasplante de Células Madre Hematopoyéticas , Humanos , Quemaduras/diagnóstico , Quemaduras/terapia , Quemaduras/complicaciones , Cicatriz/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Irán , Queratinocitos , Trasplante de Piel/efectos adversosRESUMEN
INTRODUCTION: Extensive full-thickness soft-tissue defects remain a challenge in reconstructive surgery. NovoSorb® Biodegradable Temporising Matrix (BTM) represents a novel dermal substitute and was evaluated in wounds deriving from different aetiologies and to highlight risk factors for poor take rates. METHODS: All patients treated with BTM at our department between March 2020 and October 2022 were included. Differences in univariate and linear regression models identified predictors and risk factors for take rates of BTM and split-thickness skin grafts (STSG). RESULTS: Three hundred patients (mean age 54.2 ± 20.1 years, 66.3% male, 59.7% burns, 19.7% trauma and 20.6% others) were evaluated. Mean take rates of BTM and STSG after BTM delamination were 82.7 ± 25.2% and 86.0 ± 22.6%, respectively. Multiple regression analyses showed that higher body mass index (BMI, OR 0.43, 95% CI 0.86, -0.01, p = 0.44), prior allograft transplantation (OR 15.12, 95% CI 26.98, -3.31, p = 0.041), longer trauma-to-BTM-application intervals (OR 0.01, 95% CI 0.001, -0.001, p = 0.038), positive wound swabs before BTM (OR 7.15, 95% CI 13.50, -0.80, p = 0.028) and peripheral artery disease (OR 10.80, 95% CI 18.63, -2.96, p = 0.007) were associated with poorer BTM take. Higher BMI (OR 0.40, 95% CI 0.76, -0.08, p = 0.026), increasing BTM graft surface areas (OR 0.58, 95% CI -1.00, -0.17, p = 0.005), prior allograft (OR 12.20, 95% CI -21.99, -2.41, p = 0.015) or autograft transplantations (OR 22.42, 95% CI 38.69, -6.14, p = 0.001), tumour as the aetiology of the wound (OR 37.42, 95% CI 57.41, -17.83, p = 0.001), diabetes (OR 6.64, 95% CI 12.80, -0.48, p = 0.035) and impaired kidney function (OR 5.90, 95% CI 10.94, -0.86, p = 0.021) were associated with poorer STSG take after delamination of BTM, whereas higher BTM take rates were associated with better STSG take (OR 0.40, 95% CI 0.31,0.50, p < 0.001). CONCLUSION: Extensive complex wounds of different aetiologies unsuitable for immediate STSG can be successfully reconstructed by means of two-staged BTM application and subsequent skin grafting. Importantly, presence of wound contamination or infection and prior allograft coverage appear to jeopardise good BTM and STSG take.
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Implantes Absorbibles , Trasplante de Piel , Piel Artificial , Humanos , Masculino , Persona de Mediana Edad , Femenino , Trasplante de Piel/métodos , Trasplante de Piel/efectos adversos , Adulto , Traumatismos de los Tejidos Blandos/cirugía , Traumatismos de los Tejidos Blandos/etiología , Factores de Riesgo , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Anciano , Estudios RetrospectivosRESUMEN
BACKGROUND: Paediatric donor site wounds are often complicated by dyspigmentation following a split-thickness skin graft. These easily identifiable scars can potentially never return to normal pigmentation. A Regenerative Epidermal Suspension (RES) has been shown to improve pigmentation in patients with vitiligo, and in adult patients following a burn injury. Very little is known regarding the efficacy of RES for the management of donor site scars in children. METHODS AND ANALYSIS: A pilot randomised controlled trial of 40 children allocated to two groups (RES or no RES) standard dressing applied to donor site wounds will be conducted. All children aged 16 years or younger requiring a split thickness skin graft will be screened for eligibility. The primary outcome is donor site scar pigmentation 12 months after skin grafting. Secondary outcomes include re-epithelialisation time, pain, itch, dressing application ease, treatment satisfaction, scar thickness and health-related quality of life. Commencing 7 days after the skin graft, the dressing will be changed every 3-5 days until the donor site is ≥ 95% re-epithelialised. Data will be collected at each dressing change and 3, 6 and 12 months post skin graft. ETHICS AND DISSEMINATION: Ethics approval was confirmed on 11 February 2019 by the study site Human Research Ethics Committee (HREC) (HREC/18/QCHQ/45807). Study findings will be published in peer-reviewed journals and presented at national and international conferences. This study was prospectively registered on the Australian New Zealand Clinical Trials Registry (available at https://anzctr.org.au/ACTRN12620000227998.aspx). TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry [Available at https://anzctr.org.au/ACTRN12620000227998.aspx].
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Quemaduras , Cicatriz , Adulto , Niño , Humanos , Cicatriz/etiología , Cicatrización de Heridas , Trasplante de Piel/efectos adversos , Trasplante de Piel/métodos , Calidad de Vida , Proyectos Piloto , Australia , Vendajes , Quemaduras/cirugía , Quemaduras/complicaciones , Pigmentación , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Objective: To explore the clinical efficacy of posterior femoral muscle flaps combined with posterior femoral cutaneous nerve nutrient vessel flap and closed lavage in the treatment of stage â £ ischial tuberosity pressure ulcers. Methods: This study was a retrospective observational study. From March 2021 to March 2022, 15 patients with stage â £ ischial tuberosity pressure ulcers who met the inclusion criteria were admitted to Dezhou Dongcheng Hospital, including 11 males and 4 females, aged 31 to 72 years. The pressure ulcer wound size ranged from 6.0 cm×4.5 cm to 10.0 cm×6.0 cm, with cavity diameters of 10-14 cm. Five cases were complicated with ischial tuberosity bone infection. After clearing the lesion, the biceps femoris long head muscle flap with an area of 10.0 cm×4.0 cm-18.0 cm×5.0 cm and the semitendinosus muscle flap with an area of 8.0 cm×4.0 cm-15.0 cm×5.0 cm combined with the posterior femoral cutaneous nerve nutrient vessel flap with an area of 6.5 cm×5.5 cm-10.5 cm×6.5 cm was transplanted to repair the pressure ulcer wound. The flap donor area was directly sutured, and the closed lavage with tubes inserted into the wound cavity was performed for 2-3 weeks. The postoperative survival of the muscle flaps and skin flaps, the wound healing of the donor and recipient areas were observed. The recurrence of pressure ulcers, the appearance and texture of flaps, and scar conditions of the donor and recipient areas were followed up. Results: All the muscle flaps and skin flaps in the 15 patients successfully survived after surgery. Two patients experienced incisional dehiscence at one week after surgery due to improper turning over, during which the incision in the recipient area was pressed on, and the wounds healed after dressing changes of 3 to 4 weeks; the wounds in the donor and recipient areas healed well in the other patients. All patients received follow-up after surgery. During the follow-up period of 6 to 12 months, none of the patients experienced pressure ulcer recurrence, and the texture, color, and thickness of the skin flaps closely resembled those of the surrounding skin at the recipient site, with only linear scar left in the donor and recipient areas. Conclusions: When using the posterior femoral muscle flaps combined with the posterior femoral cutaneous nerve nutrient vessel flap and closed lavage to treat stage â £ ischial tuberosity pressure ulcers, the tissue flap can be used to fully fill in the dead space of the pressure ulcers. After treatment, the wound heals well, the appearance of the donor and recipient areas is better, and the pressure ulcers are less prone to reoccur.
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Lesiones por Aplastamiento , Procedimientos de Cirugía Plástica , Úlcera por Presión , Traumatismos de los Tejidos Blandos , Femenino , Humanos , Masculino , Cicatriz/complicaciones , Lesiones por Aplastamiento/complicaciones , Músculo Esquelético/cirugía , Nutrientes , Úlcera por Presión/cirugía , Trasplante de Piel/efectos adversos , Traumatismos de los Tejidos Blandos/complicaciones , Irrigación Terapéutica/efectos adversos , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
BACKGROUND: Reconstruction of auricular defects after Mohs surgery is challenging given the prominence of the ear and its complex 3-dimensional architecture. OBJECTIVE: Evaluation of postoperative pain, healing time, and postoperative complications of auricular defects after split-thickness skin graft (STSG) placement versus secondary intent healing (SIH). MATERIALS AND METHODS: During this prospective, observational study, 30 patients recorded their daily maximum postoperative pain using the numeric pain rating scale from postoperative days 0 to 8. Surgical site healing was assessed at postoperative day 8 and 30. All postoperative complications were collected during the 30-day follow-up window. RESULTS: Patients undergoing STSG experienced significantly more pain during the first 3 postoperative days than patients in the SIH group. Maximum pain was experienced on the night of surgery, with a mean pain score of 3.6 in the STSG groups versus 0.8 in the SIH group. Healing was significantly faster in the STSG group, with 87% of patients fully healed at 1 week versus 21% in the SIH group. No major complications were experienced in either group. CONCLUSION: Split-thickness skin graft and SIH healing are well tolerated and provide excellent repair choices for auricular defects.
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Complicaciones Posoperatorias , Trasplante de Piel , Humanos , Trasplante de Piel/efectos adversos , Trasplante de Piel/métodos , Estudios Prospectivos , Dimensión del Dolor , Complicaciones Posoperatorias/etiología , Dolor Postoperatorio/etiologíaRESUMEN
BACKGROUND: The hair-bearing scalp is an underused donor site for split-thickness skin grafts (STSG). OBJECTIVE: Evaluating the donor site scar outcomes, healing times, and complications associated with STSG harvested from the hair-bearing scalp. MATERIALS AND METHODS: During this prospective observational study, donor site healing was assessed on postoperative Days 8 and 30. Donor site scar outcomes were quantified at 1 month using the Vancouver Scar Scale. All postoperative complications were collected during the 30-day follow-up window. RESULTS: 80% of donor sites was fully healed at 1-week follow-up. Vancouver Scar Scale score at the donor site was 0.26 at 1-month follow-up. All patients experienced full hair regrowth. Maximum pain scores were reported on the night of surgery (Vancouver Scar Scale 1.8), with quick resolution in days to follow. No major complications were reported. All STSG obtained from the scalp had full take and good texture and color match with the recipient site. CONCLUSION: The hair-bearing scalp is an excellent donor site for split-thickness skin graft harvesting.
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Cicatriz , Trasplante de Piel , Humanos , Cicatriz/etiología , Trasplante de Piel/efectos adversos , Cuero Cabelludo/cirugía , Cabello , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: Surgical excision combined with radiotherapy is considered an effective treatment for keloids, while the efficacy and safety of this regimen for huge keloids in patients who need reconstruction after excision is still unclear. Therefore, this study aimed to evaluate the efficacy and safety of surgical excision and reconstruction combined with radiotherapy for huge keloids in a single center with 13 years of experience. METHODS: All consecutive patients with huge keloids who underwent surgical excision and reconstruction combined with radiotherapy were identified. Demographic information, prior interventions for keloids, parameters and complications, and recurrence rates were documented. RESULTS: Twenty-one patients (10 males; mean age, 43.19 ± 18.15 years) were included, 14 patients reconstructed with z-plasties, 5 with skin grafts, and 2 with skin flaps. During a mean follow-up of 75 months, one patient developed local necrosis without the need for revision surgery and two patients developed temporary hyperpigmentation. Two patients with the z-plasties suffered partial keloids recurrence, which was healed with corticosteroid injection. No wound infection, hematoma, telangiectasia, or new keloids at donor sites were observed. The overall appearance of reconstructed defects was aesthetically acceptable. CONCLUSION: Surgical excision and reconstruction combined with radiotherapy may be safe and effective for huge keloids.
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Queloide , Masculino , Humanos , Adulto , Persona de Mediana Edad , Queloide/etiología , Queloide/radioterapia , Queloide/cirugía , Trasplante de Piel/efectos adversos , Resultado del Tratamiento , Colgajos Quirúrgicos/efectos adversos , RecurrenciaRESUMEN
BACKGROUND: Leg ulcers associated with major sickle cell disease (SCLU) are a chronic, painful complication, often treated by autologous skin graft. The analgesic effect of skin grafting in SCLU is poorly studied. The aim of this study was to evaluate the effect of skin grafting on the pain and healing of SCLU. METHODS: Patients hospitalized for SCLU skin grafting were included in a retrospective and prospective observational cohort, between 2019 and 2023: 53 autologous pinch grafts were performed on a total of 35 SCLUs in 25 sickle cell patients. The primary endpoint was the evaluation of the analgesic effect of the skin graft, measured by visual analog scale (VAS) and weekly cumulative analgesic consumption between day (D)0, D7 and D30. Wound healing was assessed by variation in wound areas between D0 and D30. RESULTS: Twenty-five patients with a median age range of 45.5years old were included, 68% were men, SS genotype was present in 96% of the cases. At D7, a significant decrease in VAS and consumption of analgesics of all classes was observed. At D30, only a significant decrease in VAS and consumption of mild opioids was present, as well as a significant reduction in wound surface area compared with D0. CONCLUSION: Pinch grafts have a significant early analgesic effect in the management of patients with SCLU, and significantly notice reduction of wound surface area within one month.
Asunto(s)
Anemia de Células Falciformes , Úlcera de la Pierna , Femenino , Humanos , Masculino , Persona de Mediana Edad , Analgésicos/uso terapéutico , Anemia de Células Falciformes/complicaciones , Úlcera de la Pierna/tratamiento farmacológico , Úlcera de la Pierna/etiología , Úlcera de la Pierna/cirugía , Dolor , Estudios Retrospectivos , Trasplante de Piel/efectos adversos , Estudios ProspectivosRESUMEN
INTRODUCTION: We report a case of a serious traffic accident injury to the lower leg involving a large skin defect with the long bone exposed. In this situation, the usual intervention is flap transplantation after debridement and infection control by completely covering the wound. Flap transplantation has certain limitations; therefore, we chose the surgical strategy of cortical bone drilling-induced membrane technology (Masquelet technique). CASE PRESENTATION: A 28-year-old healthy man was injured in a car accident and presented to the local hospital with a large skin defect and exposed left lower leg long bone. After transfer to our hospital, the patient underwent repeated debridement and skin graft, a cortex borehole combined with bone cement cover, and ankle fusion. The patient achieved full recovery. CONCLUSION: From our experience in treating this case, we conclude that large skin defects, periosteal stripping, and bone exposure due to physical injury can be successfully treated with cortical perforation and the Masquelet technique so as to avoid flap transplantation. Therefore, this method can be used for large segment bone exposure.
Asunto(s)
Traumatismos de los Tejidos Blandos , Colgajos Quirúrgicos , Masculino , Humanos , Adulto , Colgajos Quirúrgicos/cirugía , Extremidad Inferior/cirugía , Trasplante de Piel/efectos adversos , Pierna/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Traumatismos de los Tejidos Blandos/etiología , Resultado del TratamientoRESUMEN
ABSTRACT: Split-thickness skin grafting (STSG) is a common surgical procedure to manage acute and chronic wounds. A plethora of dressings exists to treat STSG donor site wounds (DSWs). Recently, a new elastomeric skin protectant was adopted (Cavilon Advanced Skin Protectant; 3M) in the treatment of incontinence-associated dermatitis. In this report, the authors assess the effects of this elastomeric skin protectant as an alternative wound dressing for STSG donor sites.The authors report a single-center prospective case series that was performed to establish a treatment protocol. Nine consecutive patients with different indications for treatment with an STSG from May to September 2018 were included. Collected data included general patient information, comorbidities, complications, blood loss, pain during dressing change, and the duration of DSW healing.This case series showed promising results in terms of duration of DSW healing when applying the elastomeric skin protectant. The authors also observed less blood loss and less pain during dressing changes. No infections were seen during the trial.
Asunto(s)
Vendajes , Trasplante de Piel , Humanos , Dolor/etiología , Trasplante de Piel/efectos adversos , Trasplante de Piel/métodos , Infección de la Herida Quirúrgica/etiología , Sitio Donante de Trasplante , Cicatrización de HeridasRESUMEN
BACKGROUND: Perifascial areolar tissue (PAT) is an areolar layer over the muscle fascia. PAT has been shown to be resistant to ischemia and prone to survival even in ischemic conditions. PAT grafts provide a vascular tissue layer on necrotic bone and tendons where skin grafting is not possible. The effect of PAT grafting on burn reconstruction has not yet been reported. Thus, in this study, we aimed to present our experience and discuss the role of PAT grafting in extremity burn reconstruction. METHODS: Between January 2019 and December 2020, 16 PAT grafting procedures were performed in 11 patients. All patients had second- or third-degree burns in the upper and lower extremities, with exposed bone or tendon. PAT grafts were harvested from the abdominal region and were used for the upper extremity in 7 patients and the lower extremity in 4 patients. Immediate skin grafting was performed during the same session. RESULTS: The patients' mean age was 50.7 years; defect size, 3.3 × 3 cm2; and follow-up time, 11.8 months. The survival rates of the PAT and skin grafts were 93.8% and 68.6%, respectively. Partial skin graft losses were encountered in 4 patients, and total skin graft loss was seen in 1 patient. CONCLUSION: PAT grafting is an alternative method to the use of dermal substitutes and flap surgery in small-to-medium-sized defects with exposed bone and tendon in burn patients.