Partial medial second toe pulp free flap and dermal substitute with skin graft for salvage reconstruction of a complete skin envelope degloving of the small finger

Background: In recent years, the composite anterolateral thigh free flap with tensor fasciae latae or vastus lateralis has been a new-applied type of flap that can provide very good reconstruction materials in complex defects of lower leg and foot. The study purpose is to evaluate the systematically complications of donor site, related factors to results of the donor area, in order to apply the result to improve the treatment, which have not been much reported in literature. Materials and Methods: Systematic donor site morbilidy evaluation in a prospective, uncontrolled clinical descriptive study of 33 composite anterolateral thigh free flaps in various forms to reconstruct anatomical structures or to resconstruct deep defects combined with covering the surfaces for complex soft tissue defects in lower extremities for 32 patients due to different causes in lower leg and foot area from 2014-2019 at Hue University of Medicine and Pharmacy. Examining and evaluating aesthetic and functional result of donor-site 3 months and 6 months up to 2 year after surgery; evaluating the correlation between the width and the type of the flaps and donor site closure methods. Result: In 33 composite flaps used, flap width to thigh circumference less than 20% in 27 cases (81.8%), more than 20% in 6 cases (18.20% ); There were 28 cases in which the donor site was directly closed, 5 cases required skin graft; All direct closed cases had flap width/ thigh circumference index below 20%; On the contrary, in cases having this index greater than 20%, the donor site required skin graft with p < 0.01. There are 11/33 (33.33%) of cases reported complications in donor site ; lateral thigh paresthesia is the most complicated complication with 8/33 cases (24.24%), followed by bad scarring 3/33 cases (9.09%). Conclusion: Long term follow up donor site morbility after composite anterior thigh free flap present 11/33 cases (33.33%): mostly complications of the donor site are thigh paresthesia with 8/33 cases (24.24%), and bad scarring 3/33 cases (9,09%), which improve time by time. Keywords: Composite anterior thigh free flap, lower extremities soft tissue defect, donor site morbidity

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Factors associated with skin graft take in fibula and radial forearm free flap donor sites

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2020.102536 ◽

2020 ◽

Vol 41 (4) ◽

pp. 102536

Author(s):

Michelle S. Hwang ◽

Christopher J. Britt ◽

Peter M. Vila ◽

Rajan P. Dang ◽

Shannon I. Fleming ◽

...

Keyword(s):

Skin Graft ◽

Free Flap ◽

Radial Forearm Free Flap ◽

Factors Associated ◽

Graft Take ◽

Radial Forearm

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Donor-Site Morbidity after Partial Second Toe Pulp Free Flap for Fingertip Reconstruction

Archives of Plastic Surgery ◽

10.5999/aps.2016.43.1.66 ◽

2016 ◽

Vol 43 (1) ◽

pp. 66-70 ◽

Cited By ~ 6

Author(s):

Hyung Su Kim ◽

Dong Chul Lee ◽

Jin Soo Kim ◽

Si Young Roh ◽

Kyung Jin Lee ◽

...

Keyword(s):

Free Flap ◽

Donor Site ◽

Donor Site Morbidity ◽

Fingertip Reconstruction ◽

Second Toe

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Use of a multilayered acellular dermal substitute with simultaneous full‐thickness skin graft for the one‐stage coverage of nasal skin defects

Journal of Cosmetic Dermatology ◽

10.1111/jocd.13342 ◽

2020 ◽

Vol 19 (11) ◽

pp. 3014-3019

Author(s):

Hi‐Jin You ◽

Young‐Soo Choi ◽

Deok‐Woo Kim

Keyword(s):

Skin Graft ◽

Dermal Substitute ◽

Full Thickness ◽

Full Thickness Skin Graft ◽

Skin Defects ◽

Full Thickness Skin ◽

One Stage ◽

Thickness Skin ◽

The One ◽

Acellular Dermal

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727 Use of a Biodegradable Dermal Matrix in Conjunction with Meshed and Sprayed Autologous Cell Suspension with a Vacuum Assisted Dressing Achieved Limb Salvage in a 73 Year Old with Deep Full Thickness Burns Despite Exposed Tendon and Bone

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.311 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S195-S195

Author(s):

Joe Olivi ◽

Megan Rodgers

Keyword(s):

Cell Suspension ◽

Limb Salvage ◽

Skin Graft ◽

Split Thickness Skin Graft ◽

Vacuum Therapy ◽

Dermal Substitute ◽

Full Thickness ◽

Dermal Matrix ◽

Autologous Cell ◽

The Right

Abstract Introduction Deep Full thickness burns require tangential excision of the burned tissues down to viable tissue. This often leaves exposed muscle, tendon and bone. Coverage of these areas is vital to limb salvage. Multiple modalities are necessary with these type of patients, such as, dermal matrix graft, split thickness skin graft, sprayed autologous cell suspension (ACS) and wound vacuum therapy(VAC). A dermal matrix provides a scaffold for tissue and vascular en growth that is suitable for accepting a skin graft and also provides a layer between the muscle, tendon, bone and the skin graft which improves movement and produces a more pliable graft. Biodegradable temporizing matrix(BTM), produced by PolyNovo Ltd, was used to cover the muscle, bone and tendon. This product has a silicone backing which can be delaminated once it has matured with tissue and vascular en growth for auto grafting. A combination of a wide meshed skin graft at 3:1 ratio and a sprayed ACS allows for faster healing and less donor site usage which decreases the overall wound burden. Methods A 73 y/o male with total body surface area burn of 24 % suffered deep full thickness burns to the bilateral lower legs. He underwent multiple debridements with management of the right leg with irrigating wound vacuum therapy. The deeper right leg had a wound base with that consisted of muscle from the thigh down onto the foot with exposed tendons and anterior tibial bone. The open wounds to the right leg were grafted with BTM for dermal substitute coverage. Once the BTM was mature it was delaminated, and the wound surface was covered with a 3:1 ratio split thickness skin graft (STSG) and sprayed on autologous cell suspension. This resulted in using less donor skin than a 1.5 or 2:1 meshed graft STSG which decreased his wound burden. Donor sites were also sprayed with ACS. Results We had nearly 100% take of the STSG and sprayed autologous suspension epidermal graft. There was a small area over the patella tendon where the BTM did not incorporate. This is though to be because of lack of immobilization of his knee and a pseudomonal infection. Donor sites healed faster and there were minimal open areas to the graft POD 11 excluding the patella area. Conclusions BTM can be used to provide a suitable dermal substitute in complex wounds when muscle, tendon and/or bone are exposed. Immobilization of the joints is necessary to allow the tissue en growth into the dermal matrix. Wide meshed graft with sprayed ACS can be used with good results with wound vacuum therapy. Decreased wound burden and time to heal open wounds of the graft and donor sites. Applicability of Research to Practice Use of a dermal matrix, wide mesh split thickness graft and sprayed epidermal ACS with wound vacuum therapy is a good option for limb salvage when vital structures are exposed.

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