Split‐thickness skin graft ( STSG ) in one‐stage procedure for severe axillary hidradenitis suppurativa

2021 ◽  
Author(s):  
Karolina Wójcicka ◽  
Piotr K. Krajewski ◽  
Jacek C. Szepietowski

2021 ◽  
Vol 97 (1) ◽  
pp. 56-63
Author(s):  
Tímea Pálházy ◽  
◽  
Stephan Bennemann ◽  
András Fülöp ◽  
L. Hunor Gergely ◽  
...  

Hidradenitis suppurativa (HS) is a chronic, recurrent infammatory disease of the hair follicles in the skinfolds containing apocrine glands, which greatly impairs the quality of life of patients. The fnal solution in extensive cases is surgical treatment. There is no ideal treatment or uniform therapeutic template equally suitable for all patients. Treatment is personalized. In this paper, we present the case of a 53-year-old patient who underwent a two-stage surgical treatment for therapy-resistant HS, Hurley stage III, causing permanent complaints. During the frst surgery, the fstula openings were flled with methylene blue, then the skin and the scary subcutaneous tissue were excised, and after 10 days, in a second step, the surgical site was covered with split thickness skin graft from the back. After both surgeries, negative pressure wound therapy (NPWT) was initiated. After the applied treatment, 98-100% graft adhesion was observed, and the patient was emitted without complaints after 3 weeks. Our case illustrates that in cases where the prospects for fap replacement in HS are poor or the healing tendency of the faps is questionable (infective wound base, poor quality surrounding skin), split thickness skin grafting combined with negative pressure therapy may be less stressful and provides a successful outcome. The combined treatment (NPWT + split thickness skin graft) is excellent not only for clearing and stimulating the wound base, but also provides an excellent wound base and allows successful wound closure / coverage, signifcantly shortening the duration of the long and cumbersome open treatment has been used so far. In this case, NPWT treatment can also be considered as a “bridging” step.



Author(s):  
Domenico Pagliara ◽  
Maria Lucia Mangialardi ◽  
Stefano Vitagliano ◽  
Valentina Pino ◽  
Marzia Salgarello

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.



BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi Lu ◽  
Ke-Chung Chang ◽  
Che-Ning Chang ◽  
Dun-Hao Chang

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.





Burns ◽  
2021 ◽  
Author(s):  
Malachy Asuku ◽  
Tzy-Chyi Yu ◽  
Qi Yan ◽  
Elaine Böing ◽  
Helen Hahn ◽  
...  


2007 ◽  
Vol 30 (1) ◽  
pp. 25-28 ◽  
Author(s):  
Birol Civelek ◽  
H. İbrahim Inal ◽  
Kubilay Ozdil ◽  
Selim Celebioglu


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