The Use of Split Thickness Skin Grafts in the Correction of Apert’s Syndactyly

2001 ◽  
Vol 26 (1) ◽  
pp. 8-10 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Skin Graft ◽  
Joint Contracture ◽  
Skin Grafts ◽  
Thickness Skin ◽  
Constant Feature ◽  
Apert's Syndrome ◽  
Web Space ◽  
Skin Graft Contraction ◽  
The Web

Stiffness of the interphalangeal joints of the fingers is a constant feature of Apert’s syndrome. Because of this stiffness, the author has used split-thickness skin grafts when correcting Apert’s syndactyly, thinking that contraction of such grafts post-operatively would not cause any joint contracture or finger deviation. This paper reports the results of eight patients whose average age at first surgery was 6 months. Separation of all digits was accomplished before the age of 2 years. A dorsal rectangular flap and interposing triangular digital flaps were utilised to create the web space and partially cover the skin defects in the fingers. The remaining digital defects were covered with thin split-thickness skin grafts which took fully in all cases. At final follow-up (1–6 years), the areas covered by skin grafts have reduced in size significantly because of skin graft contraction. However, this did not result joint contracture or digital deviation.

Results of syndactyly release using a modification of the Flatt technique

2014 ◽  
Vol 39 (9) ◽  
pp. 984-988 ◽  
Author(s):  
A. G. Barabás ◽  
M. A. Pickford
Keyword(s):  
Graft Failure ◽  
Skin Grafts ◽  
Full Thickness ◽  
Full Thickness Skin ◽  
Straight Line ◽  
Thickness Skin ◽  
The Mean ◽  
Web Space ◽  
The Web

The results of 144 congenital syndactyly releases over a 12-year period by a single surgeon using a modified Flatt technique (dorsal hourglass flap, interdigitating zigzag flaps, and full-thickness skin grafts) are analyzed considering the association of skin grafts and web creep. The mean follow-up was 5 years. There were seven cases of graft failure, only one of which developed web creep. Web creep occurred in 4.2% of web releases. The results suggest that avoiding longitudinal straight-line scars across the web space may be an important factor in avoiding web creep when performing the modified Flatt technique described.

Island Flap Reconstruction of the Web Space in Congenital Incomplete Syndactyly

2004 ◽  
Vol 29 (4) ◽  
pp. 377-380 ◽  
Author(s):  
M. D. BRENNEN ◽  
B. J. FOGARTY
Keyword(s):  
Skin Grafts ◽  
Residual Defect ◽  
Aesthetic Results ◽  
Operative Planning ◽  
Flap Design ◽  
Web Space ◽  
A New Technique ◽  
Complex Planning ◽  
The Web

A number of techniques have been described for the correction of incomplete syndactyly, some of which may produce obvious dorsal scarring of the fingers or hand while others rely on the use of skin grafts. Many of the methods require complex planning. We present our experience of a new technique which simplifies the operative planning, allows a natural looking web space to be reconstructed with minimal dorsal scarring and should minimize the need for skin grafts. Seven patients (nine webs) who underwent correction of incomplete syndactyly were reviewed (follow-up range, 6–32 months). Only one patient early on in the series required a small skin graft to cover a residual defect, following which modifications to the flap design were made. All the web spaces healed without complication and at review there were good functional and aesthetic results.

Syndactyly correction: an aesthetic reconstruction

2010 ◽  
Vol 35 (6) ◽  
pp. 446-450 ◽  
Author(s):  
R. M. Jose ◽  
N. Timoney ◽  
R. Vidyadharan ◽  
R. Lester
Keyword(s):  
Surgical Procedures ◽  
Retrospective Review ◽  
Skin Grafts ◽  
Full Thickness ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Web Space ◽  
Palmar Skin ◽  
The Web

Various flaps have been used with and without skin grafts to separate digits with syndactyly. Dorsal flap techniques with and without grafts result in dorsal and thus more visible scars. Some of the recent techniques which use no grafts are only applicable for some simple syndactylies. The technique described in this paper uses a combination of techniques which have been described previously. A shaped palmar flap is used to create the web space; narrow V-flaps and full-thickness skin grafts are used to resurface the lateral defects on the fingers and reciprocal pulp flaps are used to create aesthetically pleasing nail folds. This technique allows the full thickness grafts to be hidden on the radial and ulnar sides of the fingers and palm. It increases the span of the hand in conditions where there is shortage of palmar skin. A retrospective review has been undertaken of 102 patients in whom 221 webs were reconstructed through 176 surgical procedures. There were 54 cases of simple syndactylies (53%) and the rest were complex. Complications were encountered in 11 operations (6%) and web creep was noted in 12 web spaces (5%). Re-operation for web creep has been carried out in seven web spaces (3%).

Comparison of a new hydro-surgical technique to traditional methods for the preparation of full-thickness skin grafts from canine cadaveric skin and report of a single clinical case

2012 ◽  
Vol 25 (01) ◽  
pp. 42-48 ◽  
Author(s):  
S. C. Ralphs ◽  
G Coronado ◽  
D. C. Sweet ◽  
J. Ward ◽  
C. P. Bloch ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Skin Graft ◽  
Clinical Case ◽  
Subcutaneous Tissue ◽  
Skin Grafts ◽  
Full Thickness ◽  
Preparation Methods ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Significant Difference

SummaryObjective: To compare the hydro-surgical technique to traditional techniques for removal of subcutaneous tissue in the preparation of full-thickness skin grafts.Study design: Ex vivo experimental study and a single clinical case report.Sample population: Four canine cadavers and a single clinical case.Methods: Four sections of skin were harvested from the lateral flank of recently euthanatized dogs. Traditional preparation methods used included both a blade or scissors technique, each of which were compared to the hydro-surgical technique individually. Preparation methods were compared based on length of time for removal of the subcutaneous tissue from the graft, histologic grading, and measurable thickness as compared to an untreated sample.Results: The hydro-surgical technique had the shortest skin graft preparation time as compared to traditional techniques (p = 0.002). There was no significant difference in the histological grading or measurable subcutaneous thickness between skin specimens.Clinical significance: The hydro-surgical technique provides a rapid, effective debridement of subcutaneous tissue in the preparation of full-thickness skin grafts. There were not any significant changes in histological grade and subcutaneous tissue remaining among all treatment types. Additionally the hydro-surgical technique was successfully used to prepare a full-thickness meshed free skin graft in the reconstruction of a traumatic medial tarsal wound in a dog.Presented at the ACVS symposium during the resident seminar, Seattle, Washington,USA on October 22, 2010.

scholarly journals Autologous full-thickness skin graft as reinforcement in parastomal hernia repair: a feasibility study

2020 ◽  
Author(s):  
V. Holmdahl ◽  
U. Gunnarsson ◽  
K. Strigård
Keyword(s):  
Hernia Repair ◽  
Skin Graft ◽  
Parastomal Hernia ◽  
Complication Rates ◽  
Full Thickness ◽  
Full Thickness Skin Graft ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Parastomal Hernia Repair

Abstract Background Parastomal hernia is a common complication of stoma formation and the methods of repair available today are unsatisfactory with high recurrence and complication rates. To improve outcome after surgical repair of parastomal hernia, a surgical method using autologous full-thickness skin grafts as intraperitoneal reinforcement has been developed. The purpose of this study was to evaluate the feasibility of this novel surgical technique in the repair of parastomal hernia. Methods A pilot study was conducted between January 2018 and June 2019 on four patients with symptomatic parastomal hernia. They had a laparotomy with suture reduction of the hernia and reinforcement of the abdominal wall with autologous full-thickness skin. They were then monitored for at least 1 year postoperatively for technique-related complications and recurrence. Results No major technique-related complications were noted during the follow-up Two patients developed a recurrent parastomal hernia at the long term follow-up. The other two had no recurrence. Conclusions Autologous full-thickness skin graft as reinforcement in parastomal hernia repair is feasible and should be evaluated in a larger clinical trial.

scholarly journals Wound coverage of plantar metatarsal ulcers in leprosy using a toe web flap

2005 ◽  
Vol 38 (02) ◽  
pp. 123-127
Author(s):  
J Joshua ◽  
V Chakraborthy
Keyword(s):  
Skin Graft ◽  
Metatarsophalangeal Joint ◽  
Wound Dehiscence ◽  
Split Thickness Skin Graft ◽  
Wound Coverage ◽  
Thickness Skin ◽  
Secondary Defect ◽  
Metatarsophalangeal Joints

ABSTRACTPlantar metatarsal ulcers and sinuses are frequently seen problems in anaesthetic feet in leprosy. They may occur singly or as multiple sinuses. Many flaps have been described in the management of small defects of the forefoot. During the course of four years, from March 2000 to February 2004, a total of 708 plantar metatarsal ulcers in anaesthetic feet due to leprosy were seen. 280 surgeries were performed on 257 cases. Most of these were debridement and or excision of the metatarsophalangeal joints through a dorsal incision. Thirteen cases were dealt with by a toe web flap, using the plantar metatarsal artery as the source of supply to the flap. Nine were to cover defects under the 1st metatarsophalangeal joint. Three were to cover defects under the second and third metatarsophalangeal joints and one involved coverage of a defect under the 5th metatarsophalangeal joint. In all cases except the last, the big toe contributed the flap. In the last case the fourth toe was the donor. In all cases the flaps survived and did well. The secondary defects were covered with split thickness skin graft. Wound dehiscence was seen in one case and recurrence of a sinus, was seen in one case. Hyperkeratosis of the secondary defect was seen in three cases. Follow up ranged from 3 years to six months. We found this flap to be durable and safe with little chance of recurrence when used to cover plantar metatarsal ulcers.

Web space traction device: an effective way for the prevention of web space skin graft contraction

2012 ◽  
Vol 35 (12) ◽  
pp. 873-880
Author(s):  
Harith Abduljabbar Alani ◽  
Ahmed Abdul Razzaq ◽  
Zakaria Y. Arajy
Keyword(s):  
Skin Graft ◽  
Traction Device ◽  
Web Space ◽  
Skin Graft Contraction

scholarly journals CICAFAST: comparison of a biological dressing composed of fetal fibroblasts and keratinocytes on a split-thickness skin graft donor site versus a traditional dressing: a randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Alexandra Poinas ◽  
Pierre Perrot ◽  
Judith Lorant ◽  
Olivier Nerrière ◽  
Jean-Michel Nguyen ◽  
...  
Keyword(s):  
Wound Healing ◽  
Growth Factors ◽  
Skin Graft ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Skin Grafts ◽  
Thickness Skin ◽  
Fetal Fibroblasts ◽  
Biological Dressing ◽  
Graft Donor

Abstract Background Wound repair is one of the most complex biological processes of human life. Allogeneic cell-based engineered skin substitutes provide off-the-shelf temporary wound coverage and act as biologically active dressings, releasing growth factors, cytokines and extracellular matrix components essential for proper wound healing. However, they are susceptible to immune rejection and this is their major weakness. Thanks to their low immunogenicity and high effectiveness in regeneration, fetal skin cells represent an attractive alternative to the commonly used autologous and allogeneic skin grafts. Methods/design We developed a new dressing comprising a collagen matrix seeded with a specific ratio of active fetal fibroblasts and keratinocytes. These produce a variety of healing growth factors and cytokines which will increase the speed of wound healing and induce an immunotolerant state, with a slight inflammatory reaction and a reduction in pain. The objective of this study is to demonstrate that the use of this biological dressing for wound healing at the split-thickness skin graft (STSG) donor site, reduces the time to healing, decreases other co-morbidities, such as pain, and improves the appearance of the scar. This investigation will be conducted as part of a randomized study comparing our new biological dressing with a conventional treatment in a single patient, thus avoiding the factors that may influence the healing of a graft donor site. Discussion This clinical trial should enable the development of a new strategy for STSG donor-wound healing based on a regenerative dressing. The pain experienced in the first few days of STSG healing is well known due to the exposure of sensory nerve endings. Reducing this pain will also reduce analgesic drug intake and the duration of sick leave. Our biological dressing will meet the essential need of surgeons to “re-crop” from existing donor sites, e.g., for thermal-burn patients. By accelerating healing, improving the appearance of the scar and reducing pain, we hope to improve the conditions of treatment for skin grafts. Trial registration ClinicalTrials.gov, ID: NCT03334656. Registered on 7 November 2017.

Free Groin Flap Transfer to the Upper Extremity

HAND ◽  
1979 ◽  
Vol os-11 (3) ◽  
pp. 315-320 ◽  
Author(s):  
K. G. Shah ◽  
John C. Garrett ◽  
Harry J. Buncke
Keyword(s):  
Upper Extremity ◽  
Venous Occlusion ◽  
Skin Grafts ◽  
Flap Transfer ◽  
Groin Flap ◽  
Thickness Skin ◽  
Web Space

Seven patients underwent free groin flap transfer to the first web space, palm, wrist or elbow. Six of the seven were successful. The seventh developed acute venous occlusion and superficial necrosis of part of the flap, receiving split thickness skin grafts to salvage the dermal portion. Transfer is offered as an alternative to more conventional flaps for coverage of defects of the upper extremity.

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