Surgical treatment algorithms for post-burn contractures

Abstract Burn contractures produce restrictions in motion and unacceptable aesthetic results, frequently with persistent wounds. Proper planning and tissue selection are essential to minimize donor site morbidity optimizing outcomes. The principle of burn reconstructive surgery requires that the defects after release should be replaced with donor tissues which have matching texture and color as well as enough pliability. Autologous skin grafting or flap surgeries meet these criteria to replace scar tissues and resurface the subsequent to post-released scar defects. Despite the benefits, the use of flaps is often limited in burn patients for many reasons. If a surgeon intends to release completely and reconstruct in one-stage operation, a large defect may result in large donor site morbidity, necessitating flap surgery including free flap surgery. A lot of different methods and procedures are available for resurfacing the defects, and these are reviewed. In this article, algorithms for the release of burn contractures and reconstructive methods are presented. These treatment algorithms should aid in achieving significant improvement in both joint motions and aesthetic deformities.

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Article Commentary: Optimizing Aesthetic Results in Skin Grafting

The American Surgeon ◽

10.1177/000313481207800229 ◽

2012 ◽

Vol 78 (2) ◽

pp. 151-154 ◽

Cited By ~ 7

Author(s):

Ron Hazani ◽

Ryan Whitney ◽

Bradon J. Wilhelmi

Keyword(s):

Donor Site ◽

Skin Grafting ◽

Donor Site Morbidity ◽

Secondary Intention ◽

Donor Skin ◽

Aesthetic Results ◽

The Aesthetic ◽

Sheet Graft ◽

Surrounding Skin ◽

Tissue Defects

The aesthetic goal in skin grafting is to provide a cosmetically pleasing coverage of soft tissue defects while minimizing donor site morbidity. A skin graft should blend well with the color and texture of the surrounding skin, reduce wound size, and not interfere with the function of the reconstructed part. This review examines the key components of choosing the appropriate donor skin for a variety of defects. The decision-making process is based on the anatomic location of the defect; donor site availability; and graft size, thickness, and pigmentation. The aesthetic implications of using a sheet graft versus a meshed graft versus an expanded graft are discussed. Aside from addressing the aesthetic needs of the defect, attention is paid to the functional goals of the reconstructed part and reduced donor site morbidity. Partial graft failure can have significant deleterious effects on the aesthetic outcome of skin grafts. The need for further grafting or healing by secondary intention may result in additional scarring and deformity. Recommendations for improvement in graft take and infection control are presented.

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Full Thickness Skin Graft for Nail Unit Reconstruction

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2004.11.006 ◽

2005 ◽

Vol 30 (2) ◽

pp. 194-198 ◽

Cited By ~ 52

Author(s):

A. LAZAR ◽

P. ABIMELEC ◽

C. DUMONTIER

Keyword(s):

Skin Graft ◽

Simple Procedure ◽

Donor Site ◽

Skin Grafting ◽

Malignant Tumour ◽

Donor Site Morbidity ◽

Full Thickness ◽

Full Thickness Skin Graft ◽

Full Thickness Skin ◽

Thickness Skin

A retrospective study of 13 patients assessed the use of a full thickness skin graft for nail unit reconstruction after total nail unit removal for nail bed malignancies. No failures of the graft were observed and no patient had recurrence of the malignant tumour at 4 year follow-up. Full thickness skin grafting is a simple procedure which provides a good cosmetic outcome and does not produce significant donor site morbidity.

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Plastic and burns surgery

10.1093/med/9780198853053.003.0024 ◽

2021 ◽

pp. 647-668

Author(s):

Brian Chen ◽

Simon Davis ◽

Fynn Maguire

Keyword(s):

Surgical Procedures ◽

Free Flap ◽

Reconstructive Surgery ◽

Breast Augmentation ◽

Skin Grafting ◽

Anaesthetic Management ◽

Surgical Patients ◽

Flap Surgery ◽

Free Flap Surgery ◽

Surgical Operations

This chapter discusses the anaesthetic management of plastic and burns surgery. It begins with general principles of the anaesthetic management of plastic surgical patients. Surgical procedures covered include breast augmentation, reconstruction and reduction surgery; free flap surgery; liposuction; skin grafting and burns reconstructive surgery. The chapter includes pertinent anaesthetic features for a series of additional miscellaneous plastic surgical operations.

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Radial forearm flap surgery—evaluation of donor site morbidity

European Journal of Plastic Surgery ◽

10.1007/s00238-008-0238-y ◽

2008 ◽

Vol 31 (3) ◽

pp. 109-113 ◽

Cited By ~ 2

Author(s):

A. Thiele ◽

C. Wulke ◽

E. Roepke ◽

S. Knipping

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Radial Forearm Flap ◽

Flap Surgery ◽

Forearm Flap ◽

Radial Forearm

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Fractional Skin Harvesting: Device Operational Principles and Deployment Evaluation

Journal of Medical Devices ◽

10.1115/1.4027427 ◽

2014 ◽

Vol 8 (4) ◽

Cited By ~ 7

Author(s):

Walfre Franco ◽

Joel N. Jimenez-Lozano ◽

Joshua Tam ◽

Martin Purschke ◽

Ying Wang ◽

...

Keyword(s):

Donor Site ◽

Fluid Flows ◽

Skin Grafting ◽

Donor Site Morbidity ◽

Skin Wound ◽

Skin Tissue ◽

Hypodermic Needle ◽

Cutting Geometry ◽

Tissue Core ◽

Thickness Skin

As an alternative method to conventional split-thickness skin grafts (STSGs), we recently proposed fractional skin grafting (FSG), which consists in harvesting hundreds of microscopic skin tissue columns (MSTCs) to place them directly into the skin wound (Tam et al., 2013, “Fractional Skin Harvesting: Autologous Skin Graft Without Donor Site Morbidity,” Plast. Reconstructive Surgery–Global Open, 1(6)). This paper (i) introduces the concept and operational principles of a simple but robust fractional skin harvesting (FSH) device and (ii) presents the quantitative evaluation of the deployment of the FSH device with respect to different harvesting-needle sizes. The device utilizes a hypodermic needle with a specific cutting-geometry to core skin tissue mechanically. The tissue core is removed from the donor site into a collecting basket by air and fluid flows. The air flow transports the tissue core, while the fluid flow serves the purpose of lubrication for tissue transport and wetting for tissue preservation. The design and functionality of the device were validated in an animal study conducted to establish preclinical feasibility, safety and efficacy of the proposed FSH device and FSG method. The FSH device, operating at 55.16 kPa (8 psi) gauge pressure and 208 ml/min saline flow rate, cored 800 μm diameter × 2.5 mm length skin columns using a 1.05/0.81 mm outer/inner diameter needle. The MSTC harvesting rate was established by the user at 1 column/sec. For this columns size, about 50 MSTCs are required to cover a 1.5 cm × 1.5 cm wound. In comparison to STSGs, the proposed FSG method results in superior healing outcomes on the donor and wound sites. Most important, the donor site heals without morbidity by remodeling tissue, as opposed to scarring. The FSH device has the capability of extracting full-thickness skin columns while preserving its viability and eliminating the donor site morbidity associated with skin grafting.

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Oral Reconstruction with Free Lateral Arm Flap Analysis of Complications and Donor Site Morbidity for Patients with Advanced Stage Oral Cancer

Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences ◽

10.2478/prolas-2018-0040 ◽

2018 ◽

Vol 72 (5) ◽

pp. 268-272

Author(s):

Kalvis Pastars ◽

Jānis Zariņš ◽

Juris Tārs ◽

Anna Ivanova ◽

Andrejs Skaģers

Keyword(s):

Oral Cancer ◽

Donor Site ◽

Donor Site Morbidity ◽

Advanced Stage ◽

Lateral Arm Flap ◽

Post Surgery ◽

Free Flap Surgery ◽

Ablative Surgery ◽

Oral Reconstruction ◽

Tumour Ablation

Abstract Radial forearm flap is a gold standard for oral soft tissue defect reconstruction after tumour ablative surgery of oral cancer in advanced stages. The main disadvantage of this flap is donor site morbidity. The goal of our study was to show versatility of lateral arm flap in 34 cases with different oral defects that were reconstructed after tumour ablation, and to analyse complications and donor site morbidity. Thirty-four patients with advanced stage oral cancer (T3 and T4) underwent tumour ablation with or without suspicious lymph node removal and with immediate reconstruction of oral defect with lateral arm flap. Analysis of complications and donor sites morbidity was carried out. The Michigan Hand Outcome Questionnaire was used to evaluate functional and esthetical donor site outcome during at least one year follow up. Thirty-one patients had successful free flap surgery with uneventful post-surgery period. Flap loss due to vascularity problems was in one case (2.9%). The flap success rate was 97.1%. The donor site was closed primarily in all cases and healed uneventfully. The Michigan Hand Outcome Score was average 94.30%. The lateral arm is an excellent choice for oral reconstruction after ablative tumour surgery. It is versatile, safe and reliable for oral reconstruction with very good functional and aesthetical donor site outcome.

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Plastic surgery

10.1093/med/9780198719410.003.0019 ◽

2018 ◽

Author(s):

Jonathan Warwick

Keyword(s):

Plastic Surgery ◽

Surgical Procedures ◽

Free Flap ◽

Breast Augmentation ◽

Skin Grafting ◽

Anaesthetic Management ◽

Surgical Patients ◽

Flap Surgery ◽

Free Flap Surgery ◽

Surgical Operations

This chapter discusses the anaesthetic management of plastic surgery. It begins with general principles of the anaesthetic management of plastic surgical patients. Surgical procedures covered include breast augmentation, reconstruction, and reduction surgery, correction of prominent ears, facelift (rhytidectomy), free-flap surgery, liposuction, and skin grafting. The chapter concludes with a series of vignettes of minor plastic surgical operations.

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Donor Site Complications in Free Flap Surgery

Encyclopedia of Otolaryngology, Head and Neck Surgery ◽

10.1007/978-3-642-23499-6_772 ◽

2013 ◽

pp. 710-717

Author(s):

Steven B. Cannady ◽

Mark K. Wax

Keyword(s):

Free Flap ◽

Donor Site ◽

Flap Surgery ◽

Free Flap Surgery

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Evaluation of Fingertip Injuries and Modalities of Flap Coverage in the Emergency Settings: A Retrospective Study

QJM ◽

10.1093/qjmed/hcab105.002 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Salah Nasser Mohamed ◽

AbdelRahman AbdeIAal ◽

Mina Agaiby Estawrow ◽

Andrew Adel Wassef Attia

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Joint Stiffness ◽

Skin Grafting ◽

Free Flaps ◽

Donor Site Morbidity ◽

Tissue Loss ◽

University Hospitals ◽

Maximum Function ◽

Reconstruction Methods

Abstract Background Fingertip comprises the nail complex and glabrous pulp, which is richly vascularized and innervated, built around the distal phalanx. The fingertip is commonly affected because it is the most distal part of the hand so it's easily to be injured during athletic participation, occupational activities or in accidents. Various fingertip reconstruction methods are reported as healing by secondary intention, shortening and primary closure, skin grafts and flaps. Flaps are considered when there's a big soft tissue loss or an exposed bone. Complications of fingertip reconstructions are common such as flexion deformity and neuroma. Objective In this study, we assessed and compared the outcomes of different modalities of soft tissue covemge using different flap techniques in cases of fingertip injuries as regalding the incidence of neuroma, necrosis, donor site morbidity, joint stiffness and sensory impairment, together with the patient satisfaction. Patients and Methods We analyzed a retrospective cohort study of 90 patients with 96 fingertip injuries who underwent coverage by various flap techniques at Ain Shams University Hospitals in the period between July 2017 and July 2019. Results The V-Y Advancement flap and the Cross-finger flap were the commonest flaps done in 26 cases (27.1%) and 25 cases (26.0%) respectively. There's a highly statistically significance in the incidence of necrosis in abdominal flap (100%) followed by Moberg flap (46.2%). In addition, there is a statistically significance in the incidence of neuroma in Moberg flap (53.8%). Most of patients who underwent coverage by flap technique were very satisfied by the results (60.4%). Conclusion Many techniques have been described for reconstruction of fingertip trauma including revision amputation, skin grafting, local flaps, distant flaps and free flaps. The treatment choice depends on many factors such as patient preference, culture, resources available and surgeon skills. The goals of reconstruction in fingertip amputations are to cover the defect with a satisfactory cosmetic appearance, establish maximum function and preservation of sensation.

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