Efficacy of Wound Coverage Techniques in Extremity Necrotizing Soft Tissue Infections

2018 ◽  
Vol 84 (11) ◽  
pp. 1790-1795 ◽  
Author(s):  
Margaret H. Lauerman ◽  
Thomas M. Scalea ◽  
W. Andrew Eglseder ◽  
Raymond Pensy ◽  
Deborah M. Stein ◽  
...  
Keyword(s):  
Wound Closure ◽  
Skin Grafting ◽  
Wound Coverage ◽  
Secondary Intention ◽  
Primary Wound Closure ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Necrotizing Soft Tissue Infections ◽  
Flap Creation

Little data exist about management of wounds created by debridement in necrotizing soft tissue infections (NSTIs). Multiple wound coverage techniques exist, including complete primary wound closure, split-thickness skin grafting, secondary intention, and flap creation. We hypothesized that all wound coverage techniques would be associated with high rates of successful wound coverage and low crossover rates to other wound coverage techniques. NSTIs over a three-year period were retrospectively reviewed. Both the initial and secondary wound coverage techniques (if necessary) were recorded. The primary outcome was the ability to achieve complete wound coverage. Overall, 46 patients with NSTIs had long-term data available. Of the patients undergoing split-thickness skin grafting as the initial wound coverage technique, 8/8 (100%) achieved complete wound coverage; and of those undergoing flap creation, 1/1 (100%) achieved complete wound coverage; and of those undergoing complete primary wound closure, 4/4 (100%) achieved complete wound coverage. Of the patients undergoing secondary intention as the initial wound coverage technique, 5/33 (15.2%) achieved complete wound coverage and 28/33 (84.8%) required a secondary wound coverage technique with split-thickness skin grafting. All 46 patients achieved long-term successful wound coverage. Time to wound coverage did not vary with initial wound coverage technique ( P = 0.44). Split-thickness skin grafting, flap creation, complete primary wound closure, and secondary intention are all reasonable choices for initial wound coverage for NSTIs. Although secondary intention had a low success rate as an initial wound coverage technique, all patients ultimately achieved complete wound coverage without a significant increase in time to coverage.

Long Term Outcomes of Split-Thickness Skin Grafting to the Plantar Foot

2020 ◽  
Vol 59 (3) ◽  
pp. 498-501
Author(s):  
Elliot T. Walters ◽  
Mira Pandya ◽  
Neha Rajpal ◽  
Michel M. Abboud ◽  
Tammer Elmarsafi ◽  
...  
Keyword(s):  
Skin Grafting ◽  
Long Term Outcomes ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Shoe-Lace Technique Hasten Delayed Primary Closure In Fasciotomy Wound For Forearm Compartment Syndrome

2021 ◽  
Vol 7 (2) ◽  
pp. 76-78
Author(s):  
Mohd Asha'ari Bain ◽  
Mohd Shaffid Md Shariff ◽  
Mohamad Hilmi Mohamad Nazarallah ◽  
Nur Dina Azman ◽  
Abu 'Ubaidah Amir Norazmi
Keyword(s):  
Compartment Syndrome ◽  
Primary Closure ◽  
Open Fracture ◽  
Wound Closure ◽  
Skin Grafting ◽  
Delayed Primary Closure ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Forearm Compartment Syndrome ◽  
Good Cosmesis

We report a case of acute compartment syndrome of the forearm in a 51-year-old man with open fracture distal third radius (Gustilo I).  Decompressive fasciotomy was performed promptly. Complete progressive closure of the wound without split-thickness skin grafting was achieved using a shoe-lace technique: silastic vessel loop were interlaced held together with skin staplers placed at the edge of the fasciotomy wound and were then tightened daily. Delayed primary closure of the fasciotomy wound was performed after 8 days post fasciotomy with complete opposition of skin edges without tension. Shoelace closure is a good option for atraumatic fasciotomy wound closure with good cosmesis result.

Reconstructive options in severe cases of Hidradenitis suppurativa

Open Medicine ◽  
2010 ◽  
Vol 5 (6) ◽  
pp. 674-678 ◽  
Author(s):  
Birol Civelek ◽  
Kadir Aksoy ◽  
Esra Bilgen ◽  
Ibrahim İnal ◽  
Unal. Sahin ◽  
...  
Keyword(s):  
Hidradenitis Suppurativa ◽  
Skin Grafting ◽  
Surgical Removal ◽  
Apocrine Glands ◽  
Reconstruction Methods ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Topical Antibacterial ◽  
Systemic Antibiotics

AbstractHidradenitis suppurativa is a chronic, debilitating inflammatory disease of apocrine glands characterized with abscesses and nodular lesions. The treatment of Hidradenitis suppurativa consists of topical antibacterial or antiseptic solutions, systemic antibiotics, steroids, hormonal therapy, anti-tumor necrosis factor, and various surgical procedures. In this report, we present a series of 14 cases with severe Hidradenitis suppurativa. Surgical options are reviewed to show the best outcomes in the long term. A total of 14 patients (9 female, 5 male) were treated for advanced cases of Hidradenitis suppurativa. They underwent excision of the affected regions followed by reconstruction. The reconstruction methods consisted of split-thickness skin grafting and various cutaneous and myocutaneous flaps. There was no flap necrosis or dehiscence. One patient developed contracture in the axilla, for which he underwent release surgery. There were recurrences in 4 cases. There was no limitation of the arm movements in cases with flap reconstruction. In the long-term, they were satisfied with the results. In conclusion, incision and drainage should be avoided because it is of limited value. Surgical removal of the involved tissue should be the first treatment of choice. Depending on the defect following excision, local flaps should be preferred over the grafts for recurrence prevention.

scholarly journals Neonatal compartment syndrome

2016 ◽  
Vol 98 (7) ◽  
pp. e111-e113 ◽  
Author(s):  
B Martin ◽  
L Treharne
Keyword(s):  
Compartment Syndrome ◽  
Skin Grafting ◽  
Dermal Matrix ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Left Hand ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Contracture Release

A term neonate was born with a grossly swollen and discoloured left hand and forearm. He was transferred from the local hospital to the plastic surgical unit, where a diagnosis of compartment syndrome was made and he underwent emergency forearm fasciotomies at six hours of age. Following serial debridements of necrotic tissue, he underwent split-thickness skin grafting of the resultant defects of his forearm, hand and digits. At the clinic follow-up appointment two months after the procedure, he was found to have developed severe flexion contractures despite regular outpatient hand therapy and splintage. He has had further reconstruction with contracture release, use of artificial dermal matrix, and K-wire fixation of the thumb and wrist. Despite this, the long term outcome is likely to be an arm with poor function. The key learning point from this case is that despite prompt transfer, diagnosis and appropriate surgical management, the outcome for neonatal compartment syndrome may still be poor.

Definitive Wound Closure Techniques in Fournier's Gangrene

2018 ◽  
Vol 84 (1) ◽  
pp. 86-92
Author(s):  
Margaret Lauerman ◽  
Olga Kolesnik ◽  
Habeeba Park ◽  
Laura S. Buchanan ◽  
William Chiu ◽  
...  
Keyword(s):  
Wound Healing ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Primary Closure ◽  
Wound Closure ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Secondary Intention ◽  
Primary Wound Closure

Necrotizing soft tissue infection of the perineum, or Fournier's gangrene (FG), is a morbid and mortal diagnosis. Despite the severity of FG, the optimal definitive wound closure strategy is unknown, as are long-term wound outcomes. A retrospective review was performed over a 3-year period at a single trauma center. Patients were managed according to our institutional approach focusing on primary wound closure and secondary intention healing in residual wounds. Overall 168 patients were included. Complete primary wound closure was accomplished in 39.9 per cent of patients. Patients undergoing primary wound closure were primarily male (89.6 vs 64.4%, P < 0.001), had lower mean sequential organ failure assessment (SOFA) scores (1.70 ± 2.30 vs 2.98 ± 3.36, P = 0.004), more often had perineum-limited FG (67.2 vs 42.6%, P = 0.003), and required fewer debridements (2.40 vs 2.79, P = 0.02). On logistic regression, predictors of primary closure included gender (odds ratio 4.643, 95% confidence interval 1.885–11.437, P = 0.001) and SOFA score (odds ratio 0.834, 95% confidence interval 0.727–0.957, P = 0.01). Wound healing rates increased over time, to an 82.1 per cent wound healing rate without further intervention at greater than six months of follow-up. Wounds healed with secondary intention ranged from 70 to 9520 cm3 and primary closure ranged from 126 to 6912 cm3, whereas wounds requiring skin grafts ranged from 405 to 16,170 cm3. Complete primary wound closure is often achievable in FG patients. Using this standardized approach to FG wound management, even large wounds and wounds undergoing secondary intention healing will often close with long-term wound care and do not require flap creation or early skin grafting.

Urban Frostbite: Strategies for Limb Salvage

2019 ◽  
Vol 40 (5) ◽  
pp. 613-619 ◽  
Author(s):  
Deana S Shenaq ◽  
Maureen Beederman ◽  
Annemarie O’Connor ◽  
Megan Teele ◽  
Marla R Robinson ◽  
...  
Keyword(s):  
Thrombolytic Therapy ◽  
Skin Grafting ◽  
Urban Setting ◽  
Limb Length ◽  
Secondary Intention ◽  
Urban Patient ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Average Patient ◽  
Bone Scans

Abstract Under ideal circumstances, severely frostbitten extremities are rapidly rewarmed and treated with thrombolytic therapy within 6 to 24 hours. In an “inner city,” urban environment, most patients who suffer frostbite injuries present in a delayed fashion, sustain repeated injuries further complicated by psychological issues or intoxication, and are rarely ideal candidates for thrombolytic therapy within the prescribed timeframe. We describe our experience with the treatment of urban frostbite injuries. A retrospective review of patients with cold injuries sustained between November 2013 and March 2014 treated at a verified burn center in an urban setting was performed. Fifty-three patients were treated (42 males, 11 females). Average patient age was 41.8 years (range 2–84 years). No patients met criteria for thrombolytic therapy due to multiple freeze-thaw cycles or presentation greater than 24 hours after rewarming. Deep frostbite was seen in 10 patients. Of these patients, nine underwent debridement, resulting in partial limb amputations at levels guided by Tri-phasic technetium (Tc-99m) bone scans. Wound closure and limb-length salvage was then achieved by: free flap coverage (n = 2), local flaps (n = 8), split-thickness skin grafting (n = 22), and secondary intention healing (n = 6). While tissue plasminogen activator has been successful in reducing the need for digital amputation following frostbite injuries, in our experience, this treatment modality is not applicable to the urban patient population who often present late and after cycles of reinjury. Therefore, our approach focused on salvaging limb length with durable coverage, as the injuries were unable to be reversed.

scholarly journals Outcome of Split Thickness Skin Grafting and Multiple Z-Plasties in Postburn Contractures of Groin and Perineum: A 15-Year Experience

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Wani Sajad ◽  
Raashid Hamid
Keyword(s):  
Surgical Treatment ◽  
Skin Grafting ◽  
Cosmetic Outcome ◽  
Primary Concern ◽  
Secondary Surgery ◽  
Cosmetic Results ◽  
Cosmetic Appearance ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Background. Groin and perineal burn contracture is a rare postburn sequel. Such postburn contractures causes distressing symptoms to the patients and in the management of these contractures, both functional and cosmetic appearance should be the primary concern. Aims. To study the outcome of surgical treatment (STSG and multiple Z-plasties) in postburn contractures of groin and perineum. Material and Methods. We conducted a study of 49 patients, with postburn groin and perineal contractures. Release of contracture with split thickness skin grafting (STSG) was done in 44 (89.79%) patients and release of contracture and closure by multiple Z-plasties was done in 5 (10.21%) patients. Results. Satisfactory functional and cosmetic outcome was seen in 44 (89.79%) patients. Minor secondary contractures of the graft were seen in 3 (6.81%) patients who were managed by physiotherapy and partial recurrence of the contracture in 4 (8.16%) patients required secondary surgery. Conclusion. We conclude that postburn contractures of the groin and perineum can be successfully treated with release of contracture followed by STSG with satisfactory functional and cosmetic results. Long term measures like regular physiotherapy, use of pressure garments, and messaging with emollient creams should not be neglected and should be instituted postoperatively to prevent secondary contractures of the graft and recurrence of the contracture.

660 Decreasing Burn Excision Time by Using a Circular Dermatome

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S185-S186
Author(s):  
Alisa Savetamal ◽  
Samantha Wenta
Keyword(s):  
Operative Time ◽  
New Technology ◽  
Skin Grafting ◽  
Split Thickness Skin Graft ◽  
Large Area ◽  
Standard Equipment ◽  
Wound Coverage ◽  
Total Operative Time ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Abstract Introduction Excision of burn-injured tissue can be accomplished by a variety of means. The most commonly used tools in the burn community are straight blades of varying lengths fitted to guards of different depths. A traditional straight dermatome can also be used for excision. We describe here the use of a circular dermatome, which in addition to allowing curvilinear excision holds the promise of expediting burn excision as well. Methods IRB approval was obtained for a prospective study of the use of a circular dermatome device for the excision of burns. Patients with deep partial- and full-thickness burns were eligible for inclusion in the study. Eight patients undergoing nine procedures were included. The excisions were performed exclusively with the dermatome, with use of standard equipment only for smaller areas (hands/feet). The size of the dermatome, depth of excision, and time of excision with the dermatome were noted. Total operative time (recorded as “procedure start” to “procedure end”) was also recorded, as was the subsequent wound coverage material. Results A total of nine cases were included. The four-inch diameter blade was most commonly used, typically at depths of 25 or 30/1000thinch. The sizes of the areas excised ranged from 392cm2 to 4694 cm2. The total time of excision was short (2 to 10 minutes), and total case times varied greatly (31 to 262 minutes) due to differences in wound coverage. Excision time per cm2 was calculated in seconds due to the brevity of the excision and typically fell between 0.1 to 0.3 seconds per centimeter squared. The outlier (0.7s/cm2) was encountered early in the study and represented a challenge of technique. Cases where wound coverage was achieved with allograft or with standard split-thickness skin graft had case times of 2 to 5 seconds per square centimeter; the outlier (11s/cm2) was the result of a use of an unrelated new technology. Conclusions Rapid excision of a large area of burn can be accomplished with the circular dermatome. The device can also be used of course to take autograft. When the case consists completely of excision and allografting or conventional split-thickness skin grafting, the total operative time can be very short indeed. The dermatome may be beneficial additionally for longer cases where operating room time saved in excision may be used for other purposes.

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