Treating complex palmar–plantar wounds using a bilaminar ‘trapdoor’ technique: a case series

Objective: Due to the similarities of glabrous skin, the plantar region is an excellent donor area for covering complex palmar–plantar wounds. However, taking grafts from the plantar area often results in significant morbidity at the donor site or non-integration of the graft due to the greater thickness of the plantar corneal layer. Method: This is a prospective case series including patients with burns or wounds who have been treated with a dermal graft using the bilaminar ‘trapdoor’ technique. This procedure is used to remove a thin graft from the deep plantar dermis after the partial elevation of the first layer including the entire epidermis and superficial part of the dermis. Results: At the donor area in the four patients in this case series, we observed healing at around 10 days, and absence of hypertrophic scar in all patients. There was complete re-epithelialisation between two and three weeks from the periphery to the centre of the deep dermal graft, and from the glandular epithelium transferred with the graft. During the follow-up, patients presented aesthetic and functional features of glabrous and amelanotic skin, with similar resistance to those of the adjacent areas of the wound in the palmar–plantar region. Conclusion: This technique has some advantages, such as less surgical time, minimal morbidity in the plantar donor area, easy integration of the grafts, and maintenance of the functional and aesthetic properties of glabrous skin both in the plantar donor area and in the palmar–plantar recipient region. Declaration of interest: The authors have no conflicts of interest to declare.

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Punch Grafting for the Management of Hard-to-Heal Diabetic Foot Ulcers: A Prospective Case Series

The International Journal of Lower Extremity Wounds ◽

10.1177/15347346211031085 ◽

2021 ◽

pp. 153473462110310

Author(s):

Marta García-Madrid ◽

Irene Sanz-Corbalán ◽

Aroa Tardáguila-García ◽

Raúl J. Molines-Barroso ◽

Mateo López-Moral ◽

...

Keyword(s):

Wound Healing ◽

Clinical Outcomes ◽

Diabetic Foot ◽

Donor Site ◽

Case Series ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Wound Debridement ◽

Prospective Case Series

Punch grafting is an alternative treatment to enhance wound healing which has been associated with promising clinical outcomes in various leg and foot wound types. We aimed to evaluate the clinical outcomes of punch grafting as a treatment for hard-to-heal diabetic foot ulcers (DFUs). Six patients with chronic neuropathic or neuroischemic DFUs with more than 6 months of evolution not responding to conventional treatment were included in a prospective case series between May 2017 and December 2020. All patients were previously debrided using an ultrasound-assisted wound debridement and then, grafted with 4 to 6 mm punch from the donor site that was in all cases the anterolateral aspect of the thigh. All patients were followed up weekly until wound healing. Four (66.7%) DFUs were located in the heel, 1 (16.7%) in the dorsal aspect of the foot and 1 (16.7%) in the Achilles tendon. The median evolution time was 172 (interquartile range [IQR], 25th-75th; 44-276) weeks with a median area of 5.9 (IQR; 1.87-37.12) cm2 before grafting. Complete epithelization was achieved in 3 (50%) patients at 12 weeks follow-up period with a mean time of 5.67 ± 2.88 weeks. Two of the remaining patients achieved wound healing at 32 and 24 weeks, respectively, and 1 patient showed punch graft unsuccessful in adhering. The median time of wound healing of all patients included in the study was 9.00 (IQR; 4.00-28.00) weeks. The wound area reduction (WAR) at 4 weeks was 38.66% and WAR at 12 weeks was 88.56%. No adverse effects related to the ulcer were registered through the follow-up period. Autologous punch graft is an easy procedure that promotes healing, achieving wound closure in chronic DFUs representing an alternative of treatment for hard-to-heal DFUs in which conservative treatment has been unsuccessful.

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Reinforcement of peritoneal repair in donor site post-concurrent laparotomy and rectus abdominis myocutaneous flap breast reconstruction using autologous dermal graft repair from zone 4 of deep inferior epigastric perforator flap: A case series in Asian patients

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.182237 ◽

2016 ◽

Vol 49 (01) ◽

pp. 119-121

Author(s):

Priya Tiwari ◽

Bien Keem Tan

Keyword(s):

Breast Reconstruction ◽

Myocutaneous Flap ◽

Donor Site ◽

Case Series ◽

Perforator Flap ◽

Rectus Abdominis ◽

Dermal Graft ◽

Asian Patients ◽

Rectus Abdominis Myocutaneous Flap ◽

Deep Inferior Epigastric Perforator

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The L-shaped modification of the transverse upper gracilis (TUG) flap

European Journal of Plastic Surgery ◽

10.1007/s00238-020-01662-8 ◽

2020 ◽

Vol 43 (6) ◽

pp. 837-842

Author(s):

Juan Enrique Berner ◽

John M. D. Henton ◽

Adam Blackburn

Keyword(s):

Donor Site ◽

Case Series ◽

Diep Flap ◽

Level Of Evidence ◽

Skin Paddle ◽

Medial Thigh ◽

First Choice ◽

Prospective Case Series ◽

Tissue Flaps ◽

Therapeutic Study

AbstractA variety of free tissue flaps have been described for autologous breast reconstruction. Although the deep inferior epigastric perforator (DIEP) flap is most microsurgeons’ first choice, there is no consensus regarding which is the second-best alternative. The transverse upper gracilis (TUG) flap has gained popularity for cases where the abdomen is not a suitable donor site. This musculocutaneous flap has the advantage of an easy dissection, allowing the harvest of tissue from the medial thigh area with the patient supine. However, drawbacks include a tedious donor site closure and a limited amount of soft tissue that can be transferred. The authors hereby present a modification of the TUG flap, introducing an L-shaped skin paddle: the L-shaped upper gracilis (LUG) flap. This alternative allows harvesting extra tissue from the medial thigh, while providing an easier donor site closure with the patient supine. A prospective case series of 14 LUG flaps is presented. No flap failures or episodes of fat necrosis were encountered; only one developed a donor site seroma that settled after drainage. The LUG flap is a useful development of the TUG flap concept providing up to 50% more tissue than a standard TUG flap with an aesthetically pleasing donor site closure which is useful for cases in which abdominal flaps are not possible.Level of evidence: Level IV, therapeutic study.

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Wound bed preparation with hypochlorous acid oxidising solution and standard of care: a prospective case series

Journal of Wound Care ◽

10.12968/jowc.2021.30.10.830 ◽

2021 ◽

Vol 30 (10) ◽

pp. 830-838

Author(s):

Elia Ricci ◽

Monica Pittarello

Keyword(s):

Hypochlorous Acid ◽

Conflicts Of Interest ◽

Case Series ◽

Standard Of Care ◽

Oxidation Potential ◽

Inclusion Criteria ◽

Pain Scores ◽

High Reduction ◽

Prospective Case Series ◽

Wound Bed Preparation

Objective: This prospective case series aims to evaluate the clinical impact of a hypochlorous acid oxidising solution (AOS) in association with usual standard of care (SoC) on wound bed preparation (WBP) in patients with hard-to-heal ulcers of various aetiologies. The AOS (Nexodyn, APR Applied Pharma Research S.A., Switzerland) comprises three main features: highly pure and stabilised hypochlorous acid, acidic pH and high reduction–oxidation potential. Method: Between February 2015 and February 2017, patients who met the inclusion criteria were treated with AOS and usual SoC. Data collection ran for 70 days: T0–T70. A baseline assessment was undertaken at T0; parameters assessed at fortnightly visits included: WBP score, area and depth of ulcer, duration, pain, Bates–Jensen score and infection status. Results: A total of 60 patients took part in the study. By T70, 68.3% of wounds had healed or improved and a significant wound size reduction of 21% was observed (p<0.001), despite a mean wound duration of 20.6 months. All wounds were free of local infection and cellulitis; 10% were colonised. WBP scores improved, while Bates–Jensen and pain scores fell significantly over time. Conclusion: This evaluation suggests that AOS might represent a valuable therapeutic addition for an optimal WBP in the routine management of hard-to-heal ulcers of different aetiologies. Declaration of interest: ER worked as a consultant for APR Applied Pharma Research S.A. The authors have no other conflicts of interest.

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Safety and Efficacy of Pterygium Extended Removal Followed by Extended Conjunctival Transplant for Recurrent Pterygia

10.21203/rs.3.rs-303034/v1 ◽

2021 ◽

Author(s):

Walid Allam ◽

Ahmed Roshdy Alagorie ◽

Mohammed Nasef ◽

Molham El-Bakary

Keyword(s):

Donor Site ◽

Case Series ◽

Surgical Excision ◽

Safety And Efficacy ◽

Case Series Study ◽

Corrected Distance Visual Acuity ◽

The Mean ◽

Prospective Case Series ◽

Series Study

Abstract Purpose To study the safety and efficacy of pterygium extended removal followed by extended conjunctival transplant for recurrent pterygia. Methods Thirty-three eyes of 33 subjects with recurrent pterygia were enrolled in this prospective case series study. Pterygium extended removal followed by extended conjunctival transplantation was done for all subjects. One surgeon (WA) performed all surgeries. All subjects completed follow-up for at least 12 months and were evaluated for recurrence and complications. Results The mean age of the participants was 41.2 ± 10.3 years (range 22–60), 7 females (21.2%). The mean duration of follow-up was 25.64 ± 9.24 months (range 12–43). Corrected distance visual acuity (decimal notation) improved from 0.69 ± 0.22 (range 0.2–1.0) at presentation to a 1-year postoperative value of 0.83 ± 0.2 (range 0.3–1.0). No recurrence was reported in all subjects throughout the follow-up period. Transient graft swelling was recorded in 14 cases (42.4%) and resolved in all cases by the first week. All patients developed variable degrees of transient postoperative diplopia that resolved completely by the first 6 weeks. Donor site granuloma developed in 4 cases (12.1%). Spontaneous resolution was observed in 3 cases, while in one case, surgical excision was performed 2 months after the procedure. Conclusions In this study of eyes with recurrent pterygia, pterygium extended removal followed by extended conjunctival transplant was found safe and effective with no recurrence and minimal postoperative complications.

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PS01.044: PER-ORAL ENDOSCOPIC PYLOROMYOTOMY (G-POEM) IN THE TREATMENT OF REFRACTORY GASTROPARESIS: MID—TERM SINGLE CENTRE EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.044 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 62-62

Author(s):

Rastislav Husťak ◽

Zuzana Vackova ◽

Zuzana Rabekova ◽

Julius Spicak ◽

Jan Martinek

Keyword(s):

Conflicts Of Interest ◽

Treatment Success ◽

Case Series ◽

Clinical Effectiveness ◽

Excellent Outcome ◽

Single Center Experience ◽

Idiopathic Gastroparesis ◽

Upper Gi Endoscopy ◽

Prospective Case Series ◽

Per Oral

Abstract Background Gastroparesis is a chronic, debilitating motility disorder. Effective treatment is challenging especially in patients with severe symptoms. G-POEM is an emerging modality for refractory gastroparesis with promising preliminary results. The aim of this prospective case series was to assess the first single-center experience with G-POEM. Main outcomes were: the clinical efficacy defined by an improvement of GCSI ≥ 40% from baseline; gastric emptying study (GES) and safety. Methods Since Nov 2015, a total of 8 patients have undergone G-POEM. The etiology of gastroparesis was post-operative in 5, diabetic in 2 and idiopathic in 1 patient. One patient underwent G-POEM for gastroparesis following a multivisceral transplantation; one underwent G-POEM and POEM as a single procedure for coexisting refractory idiopathic gastroparesis and achalasia. All patients had abnormal GES. F-u visit at 3, 6, 12 and 24M were completed in 7/8 (87.5%), 7/8 (87.5%), 5/8 (62.5%) and 1/8 (12.5%) of patients, respectively. Upper GI endoscopy and GES were performed 3M after G-POEM. Results G-POEM was successfully performed in all patients. Mean procedure time was 75 minutes (range 43–106). After G-POEM, in 7 patients mean GCSI decreased from 3.26 ± 0.96 to 0.79 ± 0.76 (at 3M; P = 0.018), 0,72 ± 0.69 (6M; P = 0.018) and 1.24 ± 0.85 (12M; P = 0.028). One women finished the 24M follow maintaining excellent outcome (mean GCSI 0.77). Treatment success was reached in 6/7 (85%) of patient at 3 and 6 months. GES normalized in all patients, mean T1/2 of GES decreased from 108 ± 30 to 62 ± 23min (P = 0.018); mean residual % at 4h decreased from 17 ± 9.2% to 2.0 ± 2.0% (P = 0.018). One patient developed bleeding ulcer 10 days after G-POEM, which was successfully managed endoscopically (clips) and by a parenteral proton pump inhibitor. Conclusion We report our first experiences with G-POEM for refractory gastroparesis, demonstrating its feasibility and safety with promising mid-term efficacy. A clinical effectiveness of G-POEM needs to be assessed in a large clinical trial. Disclosure All authors have declared no conflicts of interest.

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Hard-to-heal ulcers treated with hypochlorous acid oxidising solution and standard of care: a 32-week follow-up

Journal of Wound Care ◽

10.12968/jowc.2021.30.10.840 ◽

2021 ◽

Vol 30 (10) ◽

pp. 840-844

Author(s):

Elia Ricci ◽

Monica Pittarello

Keyword(s):

Hypochlorous Acid ◽

Treatment Time ◽

Conflicts Of Interest ◽

Clinical Performance ◽

Case Series ◽

Standard Of Care ◽

Primary Study ◽

Total Treatment Time ◽

Prospective Case Series

Objective: Immediately following a two-year prospective case series in which the wounds of 60 patients with hard-to-heal ulcers were treated with a hypochlorous acid oxidising solution (AOS) in addition to standard of care (SoC) for 70 days (T0–T70), a subset of 31 patients (51.7%) whose wounds had not fully healed by T70 opted to continue with treatment for a further 22 weeks (days T70–T224, a total treatment time of 32 weeks (224 days). The objective was to provide long-term evidence on the clinical performance and safety of AOS when used in association with the usual SoC in patients with stalled, hard-to-heal ulcers of various aetiologies. Method: As per the main study, wounds were formally assessed by the study lead at 28 days (±14 days, depending on patient attendance). Parameters assessed at fortnightly visits included area, depth and duration of ulcer; pain; wound bed preparation (WBP) score; and infection status. Wounds were managed in accordance with the SoC protocol. Results: By T224, 35.5% (n=11) of wounds healed completely and 83.9% showed some types of improvement. All wounds were free of infection and colonisation, the WBP score improved (100% A1–A2 at T196), and pain scores fell. Use of AOS in combination with several types of dressing (SoC) for such a long period confirmed a good safety profile. Conclusion: This follow-up evaluation, coupled with the primary study, suggests that AOS might represent a valuable therapeutic addition for the management of hard-to-heal ulcers for long periods of treatment. Declaration of interest: ER worked as a consultant for APR Applied Pharma Research S.A. The authors have no other conflicts of interest.

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