The reconstructive approach following skin cancer excision on the lower limb: Is flap closure preferable to skin grafting?

An extensive series of skin grafting operations has been performed to investigate axial organization in the regenerating axolotl limb. Semicircular cuffs of skin from either anterior, posterior, dorsal or ventral surfaces were exchanged between right and left limbs thereby creating limbs with double anterior, double posterior, double dorsal or double ventral skin, all with normal internal tissues. Both fore and hindlimbs were used at both upper and lower limb levels. Following amputation through the grafted region the resulting regenerates were analysed both by whole-mount cartilage staining to observe the pattern of digits and by serial sectioning to observe the pattern of muscles. There were clear asymmetries in ability to produce duplications - posterior to anterior grafts resulted in a consistently high frequency of digital duplications, whereas anterior to posterior grafts produced very few. Similarly, dorsal to ventral grafts resulted in a good frequency of muscle duplications, whereas ventral to dorsal grafts did not. Such asymmetrical behaviour is not predicted by most models involving local cell:cell interactions and the significance of the results for theories of pattern formation is discussed.

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An improved alternative to vacuum-assisted closure (VAC) as a negative pressure dressing in lower limb split skin grafting: A clinical trial

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2007.01.064 ◽

2008 ◽

Vol 61 (3) ◽

pp. 334-337 ◽

Cited By ~ 21

Author(s):

Warren Matthew Rozen ◽

Shekhib Shahbaz ◽

Adel Morsi

Keyword(s):

Clinical Trial ◽

Negative Pressure ◽

Lower Limb ◽

Skin Grafting ◽

Vacuum Assisted Closure ◽

Split Skin Grafting ◽

Split Skin ◽

Pressure Dressing

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Double advancement flap closure for skin defects in the leg to avoid skin grafting

Plastic & Reconstructive Surgery ◽

10.1097/00006534-198111000-00104 ◽

1981 ◽

Vol 68 (5) ◽

pp. 839 ◽

Cited By ~ 1

Author(s):

T H Robbins

Keyword(s):

Skin Grafting ◽

Advancement Flap ◽

Skin Defects ◽

Flap Closure

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839 Early Ambulation After a Lower Limb Burn Is Associated with Reduced Length of Stay: A Quantitative Longitudinal Study

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.412 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S258-S259

Author(s):

Dale W Edgar ◽

Dana A Hince ◽

Dale O Edwick ◽

Fiona M Wood

Keyword(s):

Length Of Stay ◽

Phase I ◽

Phase Ii ◽

Lower Limb ◽

Functional Outcomes ◽

Burn Injury ◽

Unit Length ◽

Skin Grafting ◽

Early Ambulation ◽

And Function

Abstract Introduction A lower limb burn arguably has a significantly greater effect than an upper limb burn due to the detrimental impact on ambulation and return to daily roles and function. The patterns of functional recovery following a lower limb burn are poorly understood and has only been studied in small cohorts. It was hypothesized that patients, following an early ambulation pathway will have a reduced length of stay (LOS), and improved functional outcomes compared to patients with delayed ambulation after burn or after surgery. Methods The study aimed to explore if the timing of ambulation after lower limb burn and after skin grafting influenced acute LOS and functional outcomes. The study examined patients between 2011–2019 who sustained a lower limb burn injury in two phases. In Phase I, a preliminary sample (2011–2016) of 1209 lower limb burn patients with 1215 burn events was extracted and their date of ambulation confirmed retrospectively from the digital medical record. Phase II, in progress since 2017, prospectively collected the dates of ambulation. The definition of ‘early ambulation’ varies significantly and is poorly described in the literature. This study defined early and late ambulation through the categorization of four ambulatory pathways in surgically managed patients. The outcomes measured were acute LOS, and the Lower Limb Functional Index (LLFI-10) at six weeks after the burn. Conservatively managed patients were described as a reference only and not further analysed. Results Ambulatory data was available for 95% of cases, and the cohort had a mean age of 37.3 years; 65.6 % were male; and, 57% required surgery. Late ambulation was associated with TBSA; presence of a foot burn; and, when patients burn occurred in a rural area. Phase I results confirmed early ambulation, particularly after surgery, was significantly associated with reduced LOS (p< 0.001). Excluding ICU cases (n=33), median LOS increase was 2 days where ambulation was delayed after surgery. Phase I results indicated a similar trend in LLFI-10 data. The pooling and analysis of Phase I and Phase II data underway now, will substantially increase the sample size and allow definitive understanding of the influence of sub-groups such as ICU patients on the outcomes of interest. Conclusions Ambulation by 48 hours after lower limb grafting surgery is associated with reduced acute burn unit length of stay. Applicability of Research to Practice Where appropriate, achieving early ambulation within two days after surgery will assist patients to progress more rapidly on their journey towards desired participation goals.

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Strategy of Surgical Management of Peripheral Neuropathy Form of Diabetic Foot Syndrome in Ghana

Plastic Surgery International ◽

10.1155/2014/185023 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7

Author(s):

W. M. Rdeini ◽

P. Agbenorku ◽

V. A. Mitish

Keyword(s):

Diabetes Mellitus ◽

Surgical Management ◽

Surgical Procedures ◽

Lower Limb ◽

Diabetic Foot ◽

Skin Grafting ◽

Wound Management ◽

Vacuum Therapy ◽

Reconstructive Plastic

Introduction. Foot disorders such as ulceration, infection, and gangrene which are often due to diabetes mellitus are some major causes of morbidity and high amputation. Aim. This study aims to use a group of methods for the management of diabetic foot ulcers (DFU) in order to salvage the lower limb so as to reduce the rate of high amputations of the lower extremity. Materials and Methods. A group of different advanced methods for the management of DFU such as sharp debridement of ulcers, application of vacuum therapy, and other forms of reconstructive plastic surgical procedures were used. Data collection was done at 3 different hospitals where the treatments were given. Results. Fifty-four patients with type 2 diabetes mellitus were enrolled in the current study: females n=37 (68.51%) and males n=17 (31.49%) with different stages of PEDIS classification. They underwent different methods of surgical management: debridement, vacuum therapy (some constructed from locally used materials), and skin grafting giving good and fast results. Only 4 had below knee amputations. Conclusion. Using advanced surgical wound management including reconstructive plastic surgical procedures, it was possible to reduce the rate of high amputations of the lower limb.

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Topical cytotoxic drugs for skin cancer

Drug and Therapeutics Bulletin ◽

10.1136/dtb.6.14.55 ◽

1968 ◽

Vol 6 (14) ◽

pp. 55-56

Keyword(s):

Skin Cancer ◽

Cell Carcinoma ◽

Basal Cell ◽

Skin Grafting ◽

Cytotoxic Drugs ◽

Cure Rate ◽

Basal Cell Carcinomas ◽

Multiple Basal Cell Carcinomas ◽

Epidermal Carcinoma ◽

Methods Of Treatment

The main types of primary skin cancer are basal-cell carcinoma (rodent ulcer), intra-epidermal carcinoma (Bowen’s disease) and squamous-cell carcinoma. In Britain surgery and radiotherapy are the commonly used methods of treating these conditions. Both methods have a high cure rate, over 95%, but both also have some drawbacks. Surgery may require admission to hospital, general anaesthesia and skin grafting; radiotherapy requires special facilities, and can occasionally cause troublesome scarring. Radiotherapy is often undesirable, and surgery not always practical for patients with multiple basal cell carcinomas such as are found after many years’ exposure to sunlight, and those with the basal cell naevus syndrome. Other methods of treatment worth considering include curettage and cautery, which can give excellent results,1 and topical use of cytotoxic drugs.

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