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

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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Necrotizing Fasciitis in Neonate and Use of Allograft

Journal of Neonatal Surgery ◽

10.47338/jns.v8.342 ◽

2019 ◽

Vol 8 (1) ◽

pp. 8

Author(s):

Nitinkumar Borkar ◽

Phalguni Padhi ◽

Jiten Kumar Mishra ◽

Shamendra Anand Sahu ◽

Debajyoti Mohanty ◽

...

Keyword(s):

Early Diagnosis ◽

Necrotizing Fasciitis ◽

Skin Graft ◽

Subcutaneous Tissue ◽

Donor Site ◽

Subcutaneous Fat ◽

Surgical Debridement ◽

Split Thickness Skin Graft ◽

Superficial Fascia ◽

Thickness Skin

Necrotising fasciitis is a fulminant and rapidly progressive infection of the superficial fascia and subcutaneous tissue. It is rare in newborn. Trunk is the commonest site of involvement in newborns. Early diagnosis and prompt surgical debridement is the preferred treatment. Debridement in NF leads to a large raw area which may not heal by primary intention and may a split thickness skin graft for healing. Presence of minimum subcutaneous fat, loose skin and large raw area at donor site like back in some neonate poses difficulty for harvesting of skin graft. In such neonates allograft make a valuable option temporarily. Herein we report a case of a neonate with NF in whom post debridement raw area was covered with allograft from mother.

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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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Split-thickness skin graft donor-site morbidity: A systematic literature review

Burns ◽

10.1016/j.burns.2021.02.014 ◽

2021 ◽

Author(s):

Malachy Asuku ◽

Tzy-Chyi Yu ◽

Qi Yan ◽

Elaine Böing ◽

Helen Hahn ◽

...

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Skin Graft ◽

Donor Site ◽

Donor Site Morbidity ◽

Split Thickness Skin Graft ◽

Thickness Skin ◽

Graft Donor

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Diathermy of split-thickness skin graft donor site: a new technique

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2017.05.011 ◽

2017 ◽

Vol 55 (7) ◽

pp. 734-735 ◽

Cited By ~ 2

Author(s):

A.M. Holden ◽

A.N. Beech ◽

J.N. Farrier

Keyword(s):

Skin Graft ◽

Donor Site ◽

New Technique ◽

Split Thickness Skin Graft ◽

Thickness Skin ◽

Graft Donor ◽

A New Technique

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Use of Honey as an Adjunct in the Healing of Split-Thickness Skin Graft Donor Site

Dermatologic Surgery ◽

10.1097/00042728-200302000-00012 ◽

2003 ◽

Vol 29 (2) ◽

pp. 168-172

Author(s):

AYKUT MISIRLIOGLU ◽

SINEM EROGLU ◽

NACI KARACAOGLAN ◽

MITHAT AKAN ◽

TAYFUN AKOZ ◽

...

Keyword(s):

Skin Graft ◽

Donor Site ◽

Split Thickness Skin Graft ◽

Thickness Skin ◽

Graft Donor

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Wound coverage of plantar metatarsal ulcers in leprosy using a toe web flap

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699119 ◽

2005 ◽

Vol 38 (02) ◽

pp. 123-127

Author(s):

J Joshua ◽

V Chakraborthy

Keyword(s):

Skin Graft ◽

Metatarsophalangeal Joint ◽

Wound Dehiscence ◽

Split Thickness Skin Graft ◽

Wound Coverage ◽

Thickness Skin ◽

Secondary Defect ◽

Metatarsophalangeal Joints

ABSTRACTPlantar metatarsal ulcers and sinuses are frequently seen problems in anaesthetic feet in leprosy. They may occur singly or as multiple sinuses. Many flaps have been described in the management of small defects of the forefoot. During the course of four years, from March 2000 to February 2004, a total of 708 plantar metatarsal ulcers in anaesthetic feet due to leprosy were seen. 280 surgeries were performed on 257 cases. Most of these were debridement and or excision of the metatarsophalangeal joints through a dorsal incision. Thirteen cases were dealt with by a toe web flap, using the plantar metatarsal artery as the source of supply to the flap. Nine were to cover defects under the 1st metatarsophalangeal joint. Three were to cover defects under the second and third metatarsophalangeal joints and one involved coverage of a defect under the 5th metatarsophalangeal joint. In all cases except the last, the big toe contributed the flap. In the last case the fourth toe was the donor. In all cases the flaps survived and did well. The secondary defects were covered with split thickness skin graft. Wound dehiscence was seen in one case and recurrence of a sinus, was seen in one case. Hyperkeratosis of the secondary defect was seen in three cases. Follow up ranged from 3 years to six months. We found this flap to be durable and safe with little chance of recurrence when used to cover plantar metatarsal ulcers.

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Immediate Regrafting of the Split Thickness Skin Graft Donor Site Assists Healing

Plastic & Reconstructive Surgery Global Open ◽

10.1097/gox.0000000000001339 ◽

2017 ◽

Vol 5 (5) ◽

pp. e1339 ◽

Cited By ~ 6

Author(s):

Brian P. Bradow ◽

Geoffrey G. Hallock ◽

Samuel P. Wilcock

Keyword(s):

Skin Graft ◽

Donor Site ◽

Split Thickness Skin Graft ◽

Thickness Skin ◽

Graft Donor

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CICAFAST: comparison of a biological dressing composed of fetal fibroblasts and keratinocytes on a split-thickness skin graft donor site versus a traditional dressing: a randomized controlled trial

Trials ◽

10.1186/s13063-019-3718-4 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Alexandra Poinas ◽

Pierre Perrot ◽

Judith Lorant ◽

Olivier Nerrière ◽

Jean-Michel Nguyen ◽

...

Keyword(s):

Wound Healing ◽

Growth Factors ◽

Skin Graft ◽

Donor Site ◽

Split Thickness Skin Graft ◽

Skin Grafts ◽

Thickness Skin ◽

Fetal Fibroblasts ◽

Biological Dressing ◽

Graft Donor

Abstract Background Wound repair is one of the most complex biological processes of human life. Allogeneic cell-based engineered skin substitutes provide off-the-shelf temporary wound coverage and act as biologically active dressings, releasing growth factors, cytokines and extracellular matrix components essential for proper wound healing. However, they are susceptible to immune rejection and this is their major weakness. Thanks to their low immunogenicity and high effectiveness in regeneration, fetal skin cells represent an attractive alternative to the commonly used autologous and allogeneic skin grafts. Methods/design We developed a new dressing comprising a collagen matrix seeded with a specific ratio of active fetal fibroblasts and keratinocytes. These produce a variety of healing growth factors and cytokines which will increase the speed of wound healing and induce an immunotolerant state, with a slight inflammatory reaction and a reduction in pain. The objective of this study is to demonstrate that the use of this biological dressing for wound healing at the split-thickness skin graft (STSG) donor site, reduces the time to healing, decreases other co-morbidities, such as pain, and improves the appearance of the scar. This investigation will be conducted as part of a randomized study comparing our new biological dressing with a conventional treatment in a single patient, thus avoiding the factors that may influence the healing of a graft donor site. Discussion This clinical trial should enable the development of a new strategy for STSG donor-wound healing based on a regenerative dressing. The pain experienced in the first few days of STSG healing is well known due to the exposure of sensory nerve endings. Reducing this pain will also reduce analgesic drug intake and the duration of sick leave. Our biological dressing will meet the essential need of surgeons to “re-crop” from existing donor sites, e.g., for thermal-burn patients. By accelerating healing, improving the appearance of the scar and reducing pain, we hope to improve the conditions of treatment for skin grafts. Trial registration ClinicalTrials.gov, ID: NCT03334656. Registered on 7 November 2017.

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