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

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 16-20 ◽  
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.

Skin grafting after paediatric palmar burns: an analysis of 82 patients

2019 ◽  
Vol 44 (10) ◽  
pp. 1031-1035
Author(s):  
Evi M. Morandi ◽  
Elisabeth Schwabegger ◽  
Christoph Tasch ◽  
Gerhard Pierer ◽  
Gabriel Djedovic ◽  
...  
Keyword(s):  
Burn Injury ◽  
Case Series ◽  
Skin Grafting ◽  
Standard Of Care ◽  
Burn Injuries ◽  
Skin Grafts ◽  
Level Of Evidence ◽  
Paediatric Patients ◽  
Thickness Skin ◽  
Texture Match

Contact burn injuries to the palm are common in toddlers. We report a case series of 82 paediatric patients (age 7–48 months) with contact burn injury of the palm. We share our experience and outcomes of using plantar split-thickness skin grafts for resurfacing of the paediatric palm. We found that despite the excellent colour and texture match, split-thickness skin grafts from glabrous skin during growth are prone to motion-limiting scare contracture. From this series, we conclude that full-thickness skin grafts remain the reference standard of care in paediatric patients’ hands. We recommend that children with burn scars should have regular check-up examinations until they are fully grown. Level of evidence: IV

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

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S190-S191
Author(s):  
Joshua Frost ◽  
Nathan Hallier ◽  
Tanir Moreno ◽  
Jared Covell ◽  
Ryan Keck ◽  
...  
Keyword(s):  
Fibrin Glue ◽  
Skin Grafting ◽  
Skin Grafts ◽  
Inclusion Criteria ◽  
Intact Skin ◽  
Body Area ◽  
Wound Site ◽  
Graft Take ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

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.

scholarly journals Minimally Invasive Technologies for Treatment of HTS and Keloids: Fractional Laser

2020 ◽  
pp. 279-285
Author(s):  
M. Tretti Clementoni ◽  
E. Azzopardi
Keyword(s):  
Minimally Invasive ◽  
Burn Injury ◽  
State Of The Art ◽  
Skin Grafting ◽  
Complex Problem ◽  
Fractional Laser ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Insight Into

AbstractThis chapter presents a state-of-the-art insight into the use of fractional laser for the management of this complex problem. In particular, we focus on the management of complex scars such as those occurring post-burn injury and split-thickness skin grafting.

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

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.

Minced skin grafting for promoting epithelialization of the donor site after split-thickness skin grafting

Burns ◽  
2017 ◽  
Vol 43 (4) ◽  
pp. 819-823 ◽  
Author(s):  
Toru Miyanaga ◽  
Yasuo Haseda ◽  
Akihiko Sakagami
Keyword(s):  
Donor Site ◽  
Skin Grafting ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

scholarly journals A systematic review of the scalp donor site for split-thickness skin grafting

2020 ◽  
Vol 47 (6) ◽  
pp. 528-534
Author(s):  
Suk Joon Oh
Keyword(s):  
Donor Site ◽  
Age Distribution ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Late Complications ◽  
Total Rate ◽  
Thickness Skin ◽  
Pubmed Database ◽  
Split Thickness Skin Grafting ◽  
Scalp Skin

Split-thickness skin grafting (STSG) is the gold standard for coverage of acute burns and reconstructive wounds. However, the choice of the donor site for STSG varies among surgeons, and the scalp represents a relatively under-utilized donor site. Understanding the validity of potential risks will assist in optimizing wound management. A comprehensive literature search was conducted of the PubMed database to identify studies evaluating scalp skin grafting in human subjects published between January 1, 1964 and December 31, 2019. Data were collected on early and late complications at the scalp donor site. In total, 27 articles comparing scalp donor site complications were included. The selected studies included analyses of acute burn patients only (21 of 27 articles), mean total body surface area (20 of 27), age distribution (22 of 27), sex (12 of 27), ethnicity (5 of 27), tumescent technique (21 of 27), depth setting of the dermatome (24 of 27), number of harvests (20 of 27), mean days of epithelization (18 of 27), and early and late complications (27 of 27). The total rate of early complications was 3.82% (117 of 3,062 patients). The total rate of late complications was 5.19% (159 of 3,062 patients). The literature on scalp skin grafting has not yet identified an ideal surgical technique for preventing donor site complications. Although scalp skin grafting provided superior outcomes with fewer donor site complications, there continues to be a lack of standardization. The use of scalp donor sites for STSG can prevent early and late complications if proper surgical planning, procedures, and postoperative care are performed.

Facial Defect Reconstruction with Scalp Skin Grafts

2017 ◽  
Vol 33 (04) ◽  
pp. 419-422 ◽  
Author(s):  
Matthew Voorman ◽  
John Frodel ◽  
Chelsea Obourn
Keyword(s):  
Donor Site ◽  
Case Series ◽  
Donor Site Morbidity ◽  
Ear Reconstruction ◽  
Skin Grafts ◽  
Facial Skin ◽  
Skin Defects ◽  
Facial Defect ◽  
Thickness Skin ◽  
Scalp Skin

AbstractThe objective of this study is to demonstrate the benefits of scalp-based split-thickness skin grafts as a reconstructive modality for facial skin defects, noting advantages relative to traditional harvest sites. The study is presented as a case series with chart review set in a tertiary referral center. We reviewed the charts of patients with facial skin defects whose reconstruction required more skin than could be harvested with standard full-thickness skin grafting techniques and, accordingly, included a split-thickness skin graft from the adjacent scalp. Preoperative and postoperative photographs, along with operative and postoperative records, were used to evaluate final cosmetic results and complications. We reviewed 15 patients, with ages ranging from 6 to 90 years. Common indications were skin cancer resection, avulsive skin trauma, and ear reconstruction. While patients generally had good cosmetic outcomes, with excellent color matching relative to traditional distant donor sites, a major advantage of the scalp donor site was low donor-site morbidity. Scalp donor sites were commonly reepithelialized at 7 to 10 days postoperatively and had low reported pain scores. There were no major complications. Reconstruction of facial skin defects that require skin coverage with split-thickness skin grafts can optimally be harvested from adjacent scalp skin, providing adequate cosmesis but, perhaps most importantly, much lower donor-site morbidity than with traditional nonhair-bearing donor sites.

Reconstructing Forearm Free Flap Donor Sites Using Full-Thickness Skin Grafts Harvested from the Ipsilateral Arm

2020 ◽  
Vol 162 (3) ◽  
pp. 277-282
Author(s):  
Natalie A. Krane ◽  
Alia Mowery ◽  
James Azzi ◽  
Daniel Petrisor ◽  
Mark K. Wax
Keyword(s):  
Free Flap ◽  
Functional Impairment ◽  
Donor Site ◽  
Graft Loss ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Skin Grafts ◽  
Full Thickness ◽  
Full Thickness Skin ◽  
Thickness Skin

Objective To compare morbidity and aesthetic outcomes of full-thickness skin grafts (FTSGs) and split-thickness skin grafts (STSGs) in the reconstruction of the forearm free flap donor site. Study Design Case series, retrospective chart review. Setting Institutional microvascular database. Subjects and Methods Subjects who underwent forearm free flaps and FTSGs for donor site reconstruction from April 2016 to November 2017 were included. FTSGs were obtained from the donor forearm with a proximal S-shaped incision, thereby avoiding additional wound creation. Morbidity outcomes were compared to 68 consecutive patients with STSG reconstruction from January 2009 to May 2010. Complications, including tendon exposure, subjective functional impairment, complete graft loss, partial graft loss, infection, paresthesias, and hematoma/seroma, were evaluated, as were aesthetic outcomes. Results Sixty-eight patients underwent FTSG reconstruction. No significant differences between FTSGs and STSGs were demonstrated in terms of graft loss ≥40% (4% vs 4%, P = 1.000), partial graft loss (<40%) (29% vs 40%, P = .207), tendon exposure (9% vs 12%, P = .573), infection (15% vs 13%, P = .805), paresthesias (12% vs 7%, P = .382), subjective functional impairment (0% vs 2%, P = .316), or hematoma/seroma (2% vs 0%, P = .316). Aesthetic outcomes were better in the FTSG group compared to the STSG group, as determined by both patients ( P = .004) and surgeon ( P < .001). Conclusions Our results advocate for the consideration of FTSGs in the reconstruction of the forearm free flap donor site given superior aesthetic results without additional donor site morbidity or additional wound creation when compared to STSGs.

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