1291 COVID-19 And Skin Cancer Mohs Service: Are We on The Line?

Abstract Introduction Mohs surgery is a technique of surgical excision indicated for high-risk basal cell carcinomas involving contemporaneous histopathological assessment to ensure clear margins at the time of excision. Post-Mohs excision, patients should undergo reconstruction by plastic surgeons. Aim To explore the impact of the COVID-19 pandemic on a post-Mohs plastic surgery reconstructive service. Method A single-centre, retrospective analysis of patient undergoing post-Mohs reconstruction between March and September 2020 – including the first national lockdown period. This was compared with the same period in 2019. Key outcome measures included: Results In 2019, between March and September, 12 patients were referred for Mohs surgery and reconstruction versus 23 in 2020. In 2019, patients referred for Mohs waited a mean of 101 days between their clinic appointment and surgery, versus 97 days in 2020. No Mohs surgery was performed during the first lockdown and patients referred during this period waited a mean of 150 days for surgery versus 81 days in this period in 2019. The proportion of patient undergoing direct closure or full thickness skin grafting to post-Mohs defects increased by 20% while the number undergoing local flap reconstruction decreased by 12% in 2020 compared to 2019. Conclusions While overall waiting times improved in 2020, those patients referred during the lockdown experienced longer waits for Mohs surgery. The increased proportion of patients undergoing simpler reconstructive techniques in 2020 may reflect pressure on operating time due to the period of inactivity during the lockdown.

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Long-term experience with a collagen-elastin scaffold in combination with split-thickness skin grafts for the treatment of full-thickness soft tissue defects: improvements in outcome—a retrospective cohort study and case report

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02224-7 ◽

2021 ◽

Author(s):

Maximilian Lempert ◽

Sascha Halvachizadeh ◽

Clara Charlotte Salfelder ◽

Valentin Neuhaus ◽

Hans-Christoph Pape ◽

...

Keyword(s):

Cohort Study ◽

Soft Tissue ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Skin Grafting ◽

Full Thickness ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Significant Difference ◽

The Impact

Abstract Purpose The management of severe soft tissue injuries to the extremities with full-thickness wounds poses a challenge to the patient and surgeon. Dermal substitutes are used increasingly in these defects. The aim of this study was to investigate the impact of the type of injury on the success rate of Matriderm® (MD)-augmented split-thickness skin grafting, as well as the role of negative pressure wound therapy (NPWT) in preconditioning of the wounds, with a special focus on the reduction of the bioburden. Methods In this study, 45 wounds (44 affecting lower extremities (97.7%)), resulting from different types of injuries: soft tissue (ST), soft tissue complications from closed fracture (F), and open fracture (OF) in 43 patients (age 55.0 ± 18.2 years, 46.7% female), were treated with the simultaneous application of MD and split-thickness skin grafting. The study was designed as a retrospective cohort study from March 2013 to March 2020. Patients were stratified into three groups: ST, F, and OF. Outcome variables were defined as the recurrence of treated wound defects, which required revision surgery, and the reduction of bioburden in terms of reduction of number of different bacterial strains. For statistical analysis, Student’s t-test, analysis of variance (ANOVA), Mann–Whitney U test, and Pearson’s chi-squared test were used. Results There was no significant difference in the rate of recurrence in the different groups (F: 0%; OF: 11.1%; ST: 9.5%). The duration of VAC therapy significantly differed between the groups (F: 10.8 days; OF: 22.7 days; ST: 12.6 days (p < 0.05)). A clinically significant reduction of bioburden was achieved with NPWT (bacterial shift (mean (SD), F: − 2.25 (1.89); OF: − 1.9 (1.37); ST: − 2.6 (2.2)). Conclusion MD-augmented split-thickness skin grafting is an appropriate treatment option for full-thickness wounds with take rates of about 90%. The complexity of an injury significantly impacts the duration of the soft tissue treatment but does not have an influence on the take rate. NPWT leads to a relevant reduction of bioburden and is therefore an important part in the preconditioning of full-thickness wounds.

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Clinical features and outcomes of foot keloids treated using complete surgical excision and full thickness skin grafting followed by corticosteroid injections

Journal of Foot and Ankle Research ◽

10.1186/1757-1146-6-26 ◽

2013 ◽

Vol 6 (1) ◽

Cited By ~ 10

Author(s):

Tae Hwan Park ◽

Ji Hae Park ◽

Choong Hyun Chang

Keyword(s):

Clinical Features ◽

Skin Grafting ◽

Surgical Excision ◽

Full Thickness ◽

Full Thickness Skin ◽

Complete Surgical Excision ◽

Thickness Skin ◽

Corticosteroid Injections

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Intracranial Invasion of a Basal Cell Carcinoma of the Scalp

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100004595 ◽

2005 ◽

Vol 32 (4) ◽

pp. 546-548 ◽

Cited By ~ 7

Author(s):

David Mathieu ◽

David Fortin

Keyword(s):

Basal Cell Carcinoma ◽

Cell Carcinoma ◽

Dura Mater ◽

Basal Cell ◽

Skin Grafting ◽

Proximal Part ◽

Sagittal Sinus ◽

Thickness Skin ◽

Basal Cell Carcinomas ◽

Scalp Lesion

ABSTRACT:Objective and importance:Basal cell carcinomas are common lesions that can have a locally invasive behavior. The authors present a case of a scalp lesion with skull and dura-mater invasion that was unrecognized prior to surgical undertaking.Clinical presentation:A 66-year-old female presented with an extensive ulcerating lesion on the frontal scalp, deemed to be a basal cell carcinoma. The plastic surgery team brought her to the operating room for resection but subsequently backed off after the discovery of bony invasion. Imaging revealed extensive bony and epidural extension.Intervention:Resection of the invaded frontal scalp, bone, dura-mater and proximal part of the superior sagittal sinus was performed. This was followed by a reconstructive procedure consisting of a duraplasty, a cranioplasty, and a skin rotation flap and partial-thickness skin grafting.Conclusion:Radiological evaluation of scalp basal cell carcinomas should be done prior to surgery to rule out any bony or intracranial invasion.

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Refractory Cutaneous Alternariosis Successfully Treated With Mohs Surgery and Full-Thickness Skin Grafting

Dermatologic Surgery ◽

10.1097/dss.0000000000000625 ◽

2016 ◽

Vol 42 (3) ◽

pp. 426-429 ◽

Cited By ~ 1

Author(s):

Cory L. Simpson ◽

Soren Craig-Muller ◽

Joseph F. Sobanko ◽

Blair C. Weikert ◽

Robert G. Micheletti

Keyword(s):

Skin Grafting ◽

Full Thickness ◽

Mohs Surgery ◽

Full Thickness Skin ◽

Thickness Skin

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Avoiding Sutured Tie-Over Dressings on the Nasal Dorsum

Plastic Surgery International ◽

10.1155/2010/958213 ◽

2010 ◽

Vol 2010 ◽

pp. 1-2 ◽

Cited By ~ 1

Author(s):

A. Harb ◽

A. N. Pandya

Keyword(s):

Squamous Cell ◽

Skin Grafting ◽

Surgical Excision ◽

Squamous Cell Carcinomas ◽

Nasal Dorsum ◽

Full Thickness ◽

Common Site ◽

Full Thickness Skin ◽

Graft Take ◽

Thickness Skin

The nose is a common site for basal and squamous cell carcinomas. Surgical excision can leave a defect that is appropriate for reconstruction with full thickness skin grafting. Tie-over dressings have gained popularity in this setting. We propose that steri-strips alone provide the necessary support to facilitate excellent graft take.

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Improvement of Therapy Outcomes after Negative Pressure Wound Therapy in a Patient with Acne inversa.

Negative Pressure Wound Therapy Journal ◽

10.18487/npwtj.v1i1.7 ◽

2014 ◽

Vol 1 (1) ◽

Author(s):

Wojciech Francuzik ◽

Tomasz Banasiewicz ◽

Zygmunt Adamski

Keyword(s):

Negative Pressure ◽

Negative Impact ◽

Life Quality ◽

Skin Grafting ◽

Surgical Excision ◽

Visual Assessment ◽

Acne Inversa ◽

Pressure Therapy ◽

Thickness Skin ◽

Split Thickness Skin Grafting

Treatment of acne inversa (also known as hidradenitis suppurativa) is complicated and chronic. This debilitating, inflammatory disease of the follicular sacks affects mostly young adults and has a strong negative impact on their quality of life. We present a case of a 28 year old woman with a history of acneinversa of Hurley grade 2 for 6 years. Patient underwent surgical excision of the skin of the left inguinum followed by negative pressure therapy dressings for 2 and a half weeks (5 dressing changes). This allowed a full closure of the wound after 12 weeks and formation of a well accepted scar. Patient’s paindecreased from 4.5 to 1.5 according to visual assessment scale. We also noted a 28 point decrease in disease severity score according to Sartorius scale and a 19 point decrease in Dermatology Life Quality Index. Two years prior admission patient had undergone surgical treatment of her right inguinum with split thickness skin grafting, which healed for 26 weeks and yielded less satisfactory results. Comparison photographs of both treatment results are presented.

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