638 Biodegradable Temporizing Matrix in Combination with Wide Meshed Graft and Autologous Spray Cell Suspension (ASCS) Graft Can be Used for Reconstruction of Extensive Necrotizing Infections: A Case Report

Abstract Introduction Background: A necrotizing infection of the left upper extremity underwent extensive debridement with remaining exposed muscle, tendon, and bone. BTM was used to provide an acceptable temporizing matrix in conjunction with wide meshed split thickness skin graft (STSG) 3:1 ratio and ASCS graft for successful reconstruction. This left a functional limb and avoided arm forequarter amputation. Methods Case Presentation: We present a 67 y/o male with necrotizing infection who underwent extensive surgical debridement of skin and subcutaneous tissues of the left hand, forearm, and upper arm. BTM was applied for coverage over muscle, tendon, and bone to salvage his arm and avoid forequarter amputation. Following maturation of the BTM a 3:1 ratio STSG was placed along with application of an ASCS graft. A vacuum assisted closure (VAC) dressing was successfully used to stabilize the grafts. One month post grafting the wound was approximately 94% healed, with good range of motion, and limited but improving function of his arm. Results Conclusion: Necrotizing infection extremity reconstruction can be achieved with BTM, wide meshed STSG, and autologous ASCS grafting. A wound VAC provided a safe and effective dressing over these grafted mediums. Conclusions Conclusion: Necrotizing infection extremity reconstruction can be achieved with BTM, wide meshed STSG, and ASCS epidermal autograft. A wound VAC provided a safe and effective dressing over these grafted mediums.

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Split-thickness skin graft of a pedal oil burn in an adolescent female

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-81-8-435 ◽

1991 ◽

Vol 81 (8) ◽

pp. 435-439 ◽

Cited By ~ 1

Author(s):

ME Leen ◽

M Feldman ◽

S Schoenberger ◽

KC Chae

Keyword(s):

Burn Injury ◽

Skin Grafting ◽

Split Thickness Skin Graft ◽

Age Group ◽

Case Presentation ◽

Granulation Process ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Active Patient ◽

Excellent Coverage

Split-thickness skin grafting of the foot following a burn injury provides excellent coverage to promote early rehabilitation and to facilitate healing. When compared to a more slowly healing, cosmetically unacceptable secondary granulation process, grafting is especially important for the young, active patient for whom hospitalization and immobilization are difficult to maintain. Cosmetic results are also a great concern, especially in the female sector of this age group. The case presentation shows grafting as a successful means of treatment in consideration of these primary goals.

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Combined Perihamate Peripisiform and Peritrapezium Open Axial Carpal Dislocation: Description of a New Pattern of Crush Injury

Hand ◽

10.1177/1558944716681978 ◽

2016 ◽

Vol 12 (5) ◽

pp. NP73-NP77 ◽

Cited By ~ 1

Author(s):

Isidro Jiménez ◽

Martine Dury

Keyword(s):

Injury Pattern ◽

Long Term Results ◽

Wrist Flexion ◽

Left Hand ◽

Associated Lesions ◽

Thickness Skin ◽

Dislocation Type ◽

Fracture Dislocations ◽

Extensive Debridement ◽

Healthy Side

Background: Axial carpal dislocations and fracture-dislocations remain difficult to understand and to treat. The outcome is directly related to the injury pattern and long-term results are not good in most cases. Methods: 39-year-old male admitted to our emergency department after his left hand was caught between 2 rollers for 10 minutes. He was diagnosed of an open axial carpal dislocation type B (perihamate peripisiform) and type E (peritrapezium) of Garcia-Elias. An extensive debridement, reduction of the carpometacarpal dislocations and stabilization with Kirschner wires was performed requiring a full thickness skin graft 14 days after the trauma. Results: At 4-year follow-up, he had 70° of wrist extension, and 78° of wrist flexion, grip strength of 65% compared to the healthy side and x-ray showed mild signs of osteoarthritis. He was satisfied and returned to the same job. Conclusions: Axial carpal dislocations continue to be difficult injuries to address but also to classify. Since the prognosis depends on the injury pattern and other associated lesions, we believe that adding a type G which include the association of different patterns to the classification of Garcia-Elias could be useful not in changing the treatment but probably indicating a worse prognosis.

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Improving Outcomes in Anterolateral Thigh Flap Donor-Site Reconstruction Using Propeller Flaps: A Retrospective Comparative Study with Skin Grafting

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1718550 ◽

2020 ◽

Author(s):

Domenico Pagliara ◽

Maria Lucia Mangialardi ◽

Stefano Vitagliano ◽

Valentina Pino ◽

Marzia Salgarello

Keyword(s):

Comparative Study ◽

Skin Graft ◽

Donor Site ◽

Split Thickness Skin Graft ◽

Tactile Sensitivity ◽

Aesthetic Outcome ◽

Propeller Flap ◽

Thickness Skin ◽

Anterolateral Thigh ◽

Alt Flap

Abstract Background After anterolateral thigh (ALT) flap harvesting, skin graft of the donor site is commonly performed. When the defect width exceeds 8 cm or 16% of thigh circumference, it can determine lower limb function impairment and poor aesthetic outcomes. In our comparative study, we assessed the functional and aesthetic outcomes related to ALT donor-site closure with split-thickness skin graft compared with thigh propeller flap. Methods We enrolled 60 patients with ALT flap donor sites. We considered two groups of ALT donor-site reconstructions: graft group (30 patients) with split-thickness skin graft and flap group (30 patients) with local perforator-based propeller flap. We assessed for each patient the range of motion (ROM) at the hip and knee, tension, numbness, paresthesia, tactile sensitivity, and gait. Regarding the impact on daily life activities, patients completed the lower extremity functional scale (LEFS) questionnaire. Patient satisfaction for aesthetic outcome was obtained with a 5-point Likert scale (from very poor to excellent). Results In the propeller flap group, the ROMs of hip and knee and the LEFS score were significantly higher. At 12-month follow-up, in the graft group, 23 patients reported tension, 19 numbness, 16 paresthesia, 22 reduction of tactile sensitivity, and 5 alteration of gait versus only 5 patients experienced paresthesia and 7 reduction of tactile sensitivity in the propeller flap group. The satisfaction for aesthetic outcome was significantly higher in the propeller flap group. Conclusion In high-tension ALT donor-site closure, the propeller perforator flap should always be considered to avoid split-thickness skin graft with related functional and aesthetic poor results.

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A randomized single-blind controlled study of cultured epidermal allografts in the treatment of split-thickness skin graft donor sites

Archives of Dermatology ◽

10.1001/archderm.129.7.879 ◽

1993 ◽

Vol 129 (7) ◽

pp. 879-882 ◽

Cited By ~ 9

Author(s):

T. J. Phillips

Keyword(s):

Skin Graft ◽

Controlled Study ◽

Split Thickness Skin Graft ◽

Thickness Skin ◽

Graft Donor ◽

Single Blind

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Application of a Split-thickness Skin Graft after the Removal of Huge Cutaneous Squamous Cell Carcinoma on the Right Lower Posterior Neck and Right Shoulder: Case Report

Korean Society for Head and Neck Oncology ◽

10.21593/kjhno/2016.32.1.45 ◽

2016 ◽

Vol 32 (1) ◽

pp. 45-48

Author(s):

Jong Chan Kim ◽

◽

In Pyo Hong ◽

Keyword(s):

Squamous Cell Carcinoma ◽

Case Report ◽

Cell Carcinoma ◽

Squamous Cell ◽

Skin Graft ◽

Cutaneous Squamous Cell Carcinoma ◽

Split Thickness Skin Graft ◽

Thickness Skin ◽

Posterior Neck ◽

The Right

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Reconstruction of a secondary scalp defect using the crane principle and a split-thickness skin graft

BMC Surgery ◽

10.1186/s12893-021-01056-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yi Lu ◽

Ke-Chung Chang ◽

Che-Ning Chang ◽

Dun-Hao Chang

Keyword(s):

Skin Graft ◽

Subcutaneous Tissue ◽

Donor Site ◽

Split Thickness Skin Graft ◽

Salvage Procedure ◽

Primary Defect ◽

Scalp Defects ◽

Thickness Skin ◽

Scalp Defect ◽

Secondary Defect

Abstract Background Scalp reconstruction is a common challenge for surgeons, and there are many different treatment choices. The “crane principle” is a technique that temporarily transfers a scalp flap to the defect to deposit subcutaneous tissue. The flap is then returned to its original location, leaving behind a layer of soft tissue that is used to nourish a skin graft. Decades ago, it was commonly used for forehead scalp defects, but this useful technique has been seldom reported on in recent years due to the improvement of microsurgical techniques. Previous reports mainly used the crane principle for the primary defects, and here we present a case with its coincidental application to deal with a complication of a secondary defect. Case report We present a case of a 75-year-old female patient with a temporoparietal scalp squamous cell carcinoma (SCC). After tumor excision, the primary defect was reconstructed using a transposition flap and the donor site was covered by a split-thickness skin graft (STSG). Postoperatively, the occipital skin graft was partially lost resulting in skull bone exposure. For this secondary defect, we applied the crane principle to the previously rotated flap as a salvage procedure and skin grafting to the original tumor location covered by a viable galea fascia in 1.5 months. Both the flap and skin graft healed uneventfully. Conclusions Currently, the crane principle is a little-used technique because of the familiarity of microsurgery. Nevertheless, the concept is still useful in selected cases, especially for the management of previous flap complications.

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