668 Fixation of Split-Thickness Skin Grafts with Liquid Adhesive and Fibrin Glue in Place of Staples

Abstract Introduction A critical component of split-thickness skin grafting is the fixation of the skin graft to the wound site. Graft displacement can result in graft failure, especially during the initial 48–72 hours following application. The most common method of securing grafts is with the use of staples, sometimes with the addition of fibrin glue in order to aid both graft adhesion and homeostasis. The use of staples, however, is associated with significant levels of patient discomfort, especially during staple removal. A possible alternative to staples is the use of liquid adhesives, in combination with steri-strips, to anchor the edges of skin grafts to intact skin. Certain liquid adhesives, such as gum-based resins, are cheaper to use than staples and offer the potential to secure small split-thickness skin grafts without the associated pain of staples. In this pilot study, we examined the effectiveness of using a combination of gum-based resin (Gum Mastic-Storax-Msal-Alcohol), fibrin glue, and steri-strips to secure partial-thickness grafts in 8 patients without the use of staples or sutures. Methods Patients were included in the study who required split-thickness skin grafts to treat wounds involving less than or equal to 15% total surface body area and whose wounds were not located in areas prone to graft displacement, such as the axilla and groin. For each patient, skin grafts were secured using fibrin glue (sprayed over the entire wound), and a combination of liquid adhesive and steri-strips applied around the wound perimeter. The success of each graft was determined by the percentage of graft take. Results From January 1st, 2020 to April 30th, 2020, 8 patients were identified who fit the inclusion criteria. Five of the patients received grafts to their lower extremities, two patients received grafts to their upper extremities, and one of the patients received a graft to the torso. The average wound site that was grafted was 116.7 cm2. Average graft take among the 8 patients was 96.9%, with a range of 90%-100%. No complications at the graft site were noted, such as hematomas or any other event that resulted in graft displacement or failure. Conclusions The results of the study demonstrate that a combination of liquid adhesive, fibrin glue, and steri-strips, can be used as an effective alternative to staples in small split-thickness skin grafts. The use of liquid adhesive in place of staples was advantageous because it eliminated to need for staple removal, which resulted in less discomfort for the patient and less work for the nursing staff.

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Vacuum-assisted closure dressing in split-thickness skin grafting

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v10i3.1364 ◽

2019 ◽

Vol 10 (3) ◽

pp. 1735-1740

Author(s):

Ali A Ali ◽

Yasir N Qassim ◽

Ali N Areef

Keyword(s):

Skin Graft ◽

Chronic Wounds ◽

Skin Grafting ◽

Split Thickness Skin Graft ◽

Vacuum Assisted Closure ◽

Wound Site ◽

Graft Take ◽

Thickness Skin ◽

Split Thickness Skin Grafting

Vacuum-assisted closure (VAC) has been applied to a variety of acute and chronic wounds that are difficult to manage, and is associated with improved wound healing outcomes. It involves the application of sub-atmospheric pressure in a controlled way to secure a split-thickness skin graft on the wound that has been sealed with an occlusive dressing.A study was conducted on the patients with a variety of indications for skin grafting, admitted to Azadi Teaching Hospital between March 2010 and August 2017. After the application of split-thickness skin graft, a closed, controlled suction was applied on the wound. The graft was then continuously observed, and the dressing was changed as needed.A total of 39 split-thickness skin grafting procedures were performed on 37 patients (20 male, 17 female), the age of the patients ranging between 7 and 68 years. The average grafted area was 12±70 cm2, and the percent graft take ranged from 90 - 100%.Vacuum-assisted closure opposes the graft firmly on the wound bed, sucks out the seroma and/or hematoma, prevents shearing of the graft and aids in immobilization of the grafted part; thus improving the quantity and quality of the graft take. This study also established that VAC was particularly useful when the wound site is difficult to access, the wound is highly contoured and the conditions are less-than-ideal for complete graft take.

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Expansion potential of skin grafts with novel I-shaped auxetic incisions

Biomedical Physics & Engineering Express ◽

10.1088/2057-1976/ac3b72 ◽

2021 ◽

Author(s):

Vivek Gupta ◽

Arnab Chanda

Keyword(s):

Skin Grafting ◽

Burn Injuries ◽

Skin Grafts ◽

Severe Burn ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Shape Pattern ◽

Severe Burn Injuries ◽

Poisson's Ratios ◽

Poisson’S Ratios

Abstract Severe burn injures lead to millions of fatalities every year due to lack of skin replacements. While skin is a very limited and expensive entity, split thickness skin grafting, which involves the projection of a parallel incision pattern on a small section of healthy excised skin, is typically employed to increase the expansion and cover a larger burn site. To date, the real expansion capacity of such grafts are low (<3 times) and insufficient for treatment of severe burn injuries. In this study, novel I-shaped auxetic incision patterns, which are known to exhibit high negative Poisson’s ratios, have been tested on the skin to investigate their expansion potential. Fourteen two-layer skin graft models with varying incision pattern parameters (i.e., length, spacing, and orientation) were developed using finite element modelling and tested under uniaxial and biaxial tensile loads. The Poisson’s ratio, meshing ratios, and induced stresses were quantified across all models. Graft models tested uniaxially along the orthogonal directions indicated opposite trends in generated Poisson’s ratios, as the length of the I-shape incisions were increased. Biaxially, with a symmetric and closely spaced I-shape pattern, graft meshing ratios up to 15.65 were achieved without overstressing the skin. Overall, the findings from the study indicated that expansion potentials much higher than that of traditional skin grafts can be achieved with novel I-shaped auxetic skin grafts, which would be indispensable for covering large wounds in severe burn injuries.

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95 Early Clinical Experience with an Autologous Homologous Skin Construct to Treat Deep Partial-thickness and Full-thickness Burns

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.098 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S62-S62

Author(s):

Michael J Feldman ◽

Jinfeng Han ◽

Andreea C Marcu ◽

Sarah E Burkey ◽

Melissa M McLawhorn ◽

...

Keyword(s):

Adverse Events ◽

Donor Site ◽

Skin Grafting ◽

Hair Follicles ◽

Contact Friction ◽

Full Thickness ◽

Burn Wounds ◽

Graft Take ◽

Thickness Skin ◽

Split Thickness Skin Grafting

Abstract Introduction Split-thickness skin grafting (STSG) is the standard of care for treating deep burns. They often contract, have limited cosmesis, lack dermal appendages, and result in painful, conspicuous donor sites. An Autologous Homologous Skin Construct (AHSC) has been shown to result in full-thickness skin formation.1,2 This study examined the safety profile, graft take, and quality of healing of a pilot group of AHSC-treated burn wounds. Methods Following IRB approval and informed consent, patients with deep-partial/full-thickness burns requiring grafting underwent side-by-side treatment with AHSC and STSG. A 2cm2 full-thickness harvest was processed into AHSC at an FDA-registered facility, returned within 48 hours, and applied to a 4cm2 area alongside a STSG. AHSC donor site was closed primarily. Wounds were evaluated for healing with digital photography and investigator assessments for 90 days. All adverse events (AEs) were recorded. Results Eight patients with 12% TBSA [range 2–40%] burn wounds were treated; 5 Caucasian and 3 African American with an average BMI of 26.8. Injury was due to predominantly flame burn, with additional injury from grease, scald, contact, friction, and flash. Mean time between injury and AHSC treatment was 11 days [range 5–35 days]. All patients had graft take and complete epithelialization by the end of the study. Patients required one application of AHSC and no other additional surgical procedures at the application sites. The most common AEs for STSG-treated wounds included hypertrophic scarring, pruritus, and insomnia. One non-infected AHSC harvest site experienced a mechanical dehiscence. There were no other AEs related to AHSC treatment. Conclusions No related adverse events at the treatment sites were noted in this study. However, the size of the treatment area limited the ability to comment on the presence of complex dermal elements including hair follicles. Additional investigation with application to larger areas is warranted to evaluate the utility of AHSC for the treatment of acute burn wounds. Applicability of Research to Practice Novel therapy may provide an alternative treatment for burns requiring skin grafting however larger studies are needed.

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One-step approach for full-thickness skin defect reconstruction in rats using minced split-thickness skin grafts with Pelnac overlay

Burns & Trauma ◽

10.1186/s41038-019-0157-0 ◽

2019 ◽

Vol 7 ◽

Cited By ~ 2

Author(s):

Tong Liu ◽

Chao Qiu ◽

Chi Ben ◽

Haihang Li ◽

Shihui Zhu

Keyword(s):

Wound Healing ◽

Healing Rate ◽

Skin Grafting ◽

Skin Defect ◽

Skin Grafts ◽

Full Thickness ◽

Full Thickness Skin ◽

Thickness Skin ◽

Split Thickness Skin Grafting

Abstract Background Split-thickness skin grafting is the current gold standard for the treatment of traumatic skin loss. However, for patients with extensive burns, split-thickness skin grafting is limited by donor skin availability. Grafting split-thickness skin minced into micrografts increases the expansion ratio but may reduce wound repair quality. Dermal substitutes such as Pelnac can enhance the healing of full-thickness skin wounds, but their application currently requires two surgeries. The present study investigated whether it is possible to repair full-thickness skin defects and improve wound healing quality in a single surgery using Pelnac as an overlay of minced split-thickness skin grafts in a rat model. Methods A full-thickness skin defect model was established using male Sprague-Dawley rats of 10 weeks old. The animals were randomly divided into control and experimental groups in which Vaseline gauze and Pelnac, respectively, were overlaid on minced split-thickness skin grafts to repair the defects. Wound healing rate and quality were compared between the two groups. For better illustration of the quality of wound healing, some results were compared with those obtained for normal skin of rats. Results We found that using Pelnac as an overlay for minced split-thickness skin grafts accelerated wound closure and stimulated cell proliferation and tissue angiogenesis. In addition, this approach enhanced collagen synthesis and increased the formation of basement membrane and dermis as well as the expression of growth factors related to wound healing while reducing scar formation. Conclusions Using minced split-thickness skin grafts overlaid with Pelnac enables the reconstruction of full-thickness skin defects in a single step and can increase the healing rate while improving the quality of wound healing.

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Outcomes of split vs full-thickness skin grafts in scalp reconstruction in outpatient local anaesthetic theatre

Scars Burns & Healing ◽

10.1177/20595131211056542 ◽

2021 ◽

Vol 7 ◽

pp. 205951312110565

Author(s):

Luxi Sun ◽

Animesh JK Patel

Keyword(s):

Skin Graft ◽

Local Anaesthetic ◽

Skin Grafting ◽

Skin Grafts ◽

Full Thickness ◽

Full Thickness Skin ◽

Graft Take ◽

Thickness Skin ◽

Graft Reconstruction ◽

Scalp Skin

Background Surgical excision remains the cornerstone of simultaneous diagnosis and treatment of suspicious skin lesions, and the scalp is a high-risk area for skin cancers due to increased cumulative lifetime ultraviolet (UV) exposure. Due to the inelasticity of scalp skin, most excisions with predetermined margins require reconstruction with skin grafting. Methods A retrospective single-centre cohort study was performed of all patients undergoing outpatient local anaesthetic scalp skin excision and skin graft reconstruction in the Plastic Surgery Department at Addenbrookes Hospital over a 20-month period between 1 April 2017 and 1 January 2019. In total, 204 graft cases were collected. Graft reconstruction techniques included both full-thickness and split-thickness skin grafts. Statistical analysis using Z tests were used to determine which skin grafting technique achieved better graft take. Results Split-thickness skin grafts had a statistically significant ( P = 0.01) increased average take (90%) compared to full-thickness skin grafts (72%). Using a foam tie-over dressing on the scalp led to a statistically significant ( P = 0.000036) increase in skin graft take, from 38% to 79%. Conclusion In skin graft reconstruction of scalp defects after skin cancer excision surgery, split skin grafts secured with foam tie-over dressings are associated with superior outcomes compared to full-thickness skin grafts or grafts secured with sutures only.

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Acellular Fish Skin Grafts for Management of Split Thickness Donor Sites and Partial Thickness Burns: A Case Series

Military Medicine ◽

10.1093/milmed/usy280 ◽

2019 ◽

Vol 184 (Supplement_1) ◽

pp. 16-20 ◽

Cited By ~ 4

Author(s):

Khurshid Alam ◽

Steven L A Jeffery

Keyword(s):

Burn Injury ◽

Donor Site ◽

Case Series ◽

Skin Grafting ◽

Viral Disease ◽

Skin Substitute ◽

Skin Grafts ◽

Fish Skin ◽

Thickness Skin ◽

Split Thickness Skin Grafting

Abstract When treating large burns, autologous skin availability becomes a problem and burn surgeons rely heavily on allogenic and xenogeneic skin for temporary coverage after excision. Application of cadaveric and pig skin grafts carries a risk of auto-immune response and risk of viral and bacterial diseases transmission, and there are many cultural and religious rejections for use of porcine grafts. There has recently become available an alternative resource of xenograft using acellular fish skin (KerecisTM Omega3 Burn). This has been described as providing an effective, safe, efficient skin substitute, free of the risk of transmission of viral disease, and auto-immune reaction risk. Methods Ten patients having split-thickness skin grafting for burn injury were treated with the fish skin xenografts. Results There were no adverse reactions noted on the use of the fish skin grafts. No patient had any reaction to the fish skin and there was a zero incidence of infection. The handling of the fish skin was excellent, a robust and pliable xenograft that was easy to apply. The quality of donor site healing was judged to be good in all cases. Both the analgesic effect noted and the relatively short average times until 100% re-epithelialization are promising. We also illustrate two cases where the dressing was used to treat superficial burns.

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Thin and Ultra-Thin Split-Thickness Skin Grafts Are Safe and Efficacious in the Burn Population

Journal of Burn Care & Research ◽

10.1093/jbcr/irz208 ◽

2019 ◽

Vol 41 (4) ◽

pp. 849-852

Author(s):

Miranda A Chacon ◽

Jacqueline Haas ◽

Trevor C Hansen ◽

Oren P Mushin ◽

Derek E Bell

Keyword(s):

Physical Therapy ◽

Functional Outcomes ◽

Cohort Analysis ◽

Donor Site ◽

Burn Patients ◽

Skin Grafts ◽

Inclusion Criteria ◽

Graft Take ◽

Thickness Skin ◽

Surgeon Experience

Abstract Split-thickness skin-grafts are a mainstay of burn management. Studies suggest no benefit to using thick (0.025 inch) over standard (0.012–0.020 inch) grafts, and some support the use of thin (0.008 inch) over standard thickness. Data on the use of even thinner grafts is scarce. This study reviewed outcomes of burn patients treated with thin (0.008–0.011 inch) and ultra-thin (≤0.007 inch) grafts. Retrospective review of records from July 2012 to June 2016 included patients who sustained operative burns treated by a single surgeon. Patients were excluded for nonoperative injuries, inhalational injuries, or prolonged hospitalizations. Outcome measures were compared between thin and ultra-thin groups. One-hundred twenty-eight patients met inclusion criteria; 35 received thin split-thickness skin-grafts while 93 received ultra-thin. Cohort analysis demonstrated equivalent graft-take, time to reepithelialization, and functional outcomes. Time to donor-site healing was significantly faster in the ultra-thin cohort (P = .04). Of those with functional outcomes recorded, 88.1% had good-excellent function and 11.9% retained a limitation in function as designated in physical therapy notes. There were fewer complications overall (P = .004) and a lower incidence of hypertrophic scarring (P = .025) in the ultra-thin cohort. This study presents a single-surgeon experience with thin and ultra-thin split-thickness skin-grafts. These grafts are exhibit excellent graft-take and few complications. There was no correlation between thickness and functional outcome at the time of physical therapy discharge. Donor-site reepithelialization was faster with ultra-thin grafts, which may be important in patients with large burns and limited donor sites.

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Tumescent non-tumescent technique for split thickness skin graft harvesting

International Surgery Journal ◽

10.18203/2349-2902.isj20185038 ◽

2018 ◽

Vol 5 (12) ◽

pp. 4026

Author(s):

M. K. Rajendran

Keyword(s):

Blood Loss ◽

Skin Graft ◽

Donor Site ◽

Skin Grafting ◽

Split Thickness Skin Graft ◽

Skin Grafts ◽

Recipient Site ◽

Tumescent Technique ◽

Graft Take ◽

Thickness Skin

Background: Split-thickness skin graft failures can be attributed to flaws in the recipient bed which has to be well prepared. Tissues with limited blood supply such as bone, tendons, cartilage or sites with necrotic tissue or infection do not accept skin grafts. Adrenaline is used to harvest skin grafts due to its vasoconstriction effect which limits blood loss. The aim of our study was to determine skin graft take after tumescent technique compared to a non-tumescent technique for harvesting.Methods: Two treatment groups of patients who fulfilled the inclusion criteria were randomly assigned. Forty patients underwent split-thickness skin graft harvesting with tumescent technique and forty patients underwent non-tumescent split-thickness skin graft harvesting. The recipient site was opened in both groups on the fifth day after surgery and take rate assessed. The donor site was assessed on day ten and if not healed, followed up for three weeks.Results: There was a statistically significant association between skin graft take rate and skin grafting technique (p=0.011). The mean graft take rate was 2.5% higher in the tumescent group compared to the non-tumescent group (96.3% compared to 94%). On day 10, there was no difference in percentage healing of donor sites between the tumescent and non-tumescent groups, p=0.562.Conclusions: Tumescent technique significantly reduced intraoperative blood loss. It is safe, inexpensive and easy to use. The subdermal adrenaline/saline injection creates a smooth, dense surface which assists debridement and donor harvesting.

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