scholarly journals Tumescent versus non-tumescent technique in skin graft healing: a cross-sectional study

2018 ◽  
Vol 5 (5) ◽  
pp. 1822
Author(s):  
Ramesh Koujalagi ◽  
V. M. Uppin ◽  
Rajesh Pawar ◽  
Vaibhav Avinash Patil
Keyword(s):  
Blood Loss ◽  
Skin Graft ◽  
Healing Rate ◽  
Donor Site ◽  
Skin Grafting ◽  
Tumescent Technique ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Group A ◽  
Group B

Background: Skin grafting, especially burn surgery, is associated with great blood loss. Tumescent technique is the subdermal injection of fluid containing a vasoconstrictor prior to burn wound surgery to reduce blood loss. Adrenaline is used to harvest skin grafts due to its vasoconstriction effect which limits blood loss. Although adrenaline is widely used, its local and systemic effects vary from patient to patient. The object of the present study was to observe the efficacy of tumescent technique, using adrenaline, versus non-tumescent technique in the healing of split thickness skin graft donor day 10.Methods: Two treatment groups of patients, tumescent (group A, n = 45) and non-tumescent technique (group B, n = 45), who fulfilled the inclusion criteria were randomly assigned. Tumescent technique involved administration of 1 mg (1:1000) adrenaline in 500 mL of saline. No prior administration of agent was performed in non-tumescent technique. Split-thickness skin grafting was carried out followed by regular inspection of the donor site. Healing rate was recorded at the postoperative day 10 by performing wound tracing technique and evaluated by performing unpaired t-test. P <0.05 was considered as statistically significant. Results: The mean age of patients was 29.98±12.6 years in group A and 45.36±10.23 years in group B. Age distribution was concentrated between 18 and 38 years. On postoperative day 10, complete epithelialization was observed in 15.56 % and 6.66% of patients in group A and B, respectively. Compared to the patients in group B, patients who underwent tumescent technique (group A) had higher healing rate (>80%, p=0.0134). Evidence of infection in the donor site was absent in both the groups.Conclusions: Tumescent technique by using adrenaline is more effective than non-tumescent technique in the healing of donor site and can be implemented preoperatively in split-thickness skin grafting.

scholarly journals Comparison of the effectiveness of Ropivacaine soaked vs bupivacaine soaked dressing for pain relief at split thickness skin graft donor site.

2020 ◽  
Vol 27 (09) ◽  
pp. 1952-1957
Author(s):  
Abdul Malik Mujahid ◽  
Farrukh Aslam Khalid ◽  
Kashif Mehmood Sheikh ◽  
Muhammad Sheraz Raza ◽  
Husnain Khan ◽  
...  
Keyword(s):  
Pain Relief ◽  
Rating Scale ◽  
Donor Site ◽  
Skin Grafting ◽  
Tissue Loss ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Group A ◽  
The Mean ◽  
Group B

Objectives: To compare the mean pain score of ropivacaine soaked dressing versus bupivacaine-soaked dressing for pain relief at the donor site among patients requiring split thickness skin grafting after burns and tissue loss. Study Design: (RCT) Randomized control trial. Setting: Department of Plastic Surgery Jinnah Burn and Reconstructive Surgery Center Lahore. Period: January 1, 2019 to June 31, 2019. Material & Methods: Total 120 patients meeting the inclusion criteria were enrolled and divided randomly into Group-A and Group-B based on lottery method. Group A was dressed with ropivacaine soaked dressing while group-B with bupivacaine-soaked dressing. Patients were asked about pain four hours after the dressing using the verbal rating scale of 0-10. Result: Total 120 patients were included and randomly divided in to two groups. The mean age of ropivacaine group (Group A) patients was 40.82±13.20 years and bupivacaine group (Group-B) patients was 39.70±12.20 years. 56(46.67%) patients were males and 64(53.33%) patients were females.  Male to female ratio was 0.8:1. The mean size of the defect for Group-A patients was 10.43±2.92 and Group B patients was 10.13±2.91. The Mean Visual Rating Scale (VRS) at the baseline for ropivacaine was 7.95 ± 1.04 and for bupivacaine was 8.0167 ±.791 (p =0.695) and VRS (verbal rating scale) at 4 hours of ropivacaine group patients was 1.27±1.13 and in bupivacaine group patients was 2.58±1.61. The statistically significant difference is found between the two study groups for VRS at 4 hours (p-value=0.001). Conclusion: Ropivacaine soaked dressing showed significantly better outcome than bupivacaine-soaked dressing at the donor site among patients requiring split thickness skin grafting after burns and tissue loss.

scholarly journals Tumescent non-tumescent technique for split thickness skin graft harvesting

2018 ◽  
Vol 5 (12) ◽  
pp. 4026
Author(s):  
M. K. Rajendran
Keyword(s):  
Blood Loss ◽  
Skin Graft ◽  
Donor Site ◽  
Skin Grafting ◽  
Split Thickness Skin Graft ◽  
Skin Grafts ◽  
Recipient Site ◽  
Tumescent Technique ◽  
Graft Take ◽  
Thickness Skin

Background: Split-thickness skin graft failures can be attributed to flaws in the recipient bed which has to be well prepared. Tissues with limited blood supply such as bone, tendons, cartilage or sites with necrotic tissue or infection do not accept skin grafts. Adrenaline is used to harvest skin grafts due to its vasoconstriction effect which limits blood loss. The aim of our study was to determine skin graft take after tumescent technique compared to a non-tumescent technique for harvesting.Methods: Two treatment groups of patients who fulfilled the inclusion criteria were randomly assigned. Forty patients underwent split-thickness skin graft harvesting with tumescent technique and forty patients underwent non-tumescent split-thickness skin graft harvesting. The recipient site was opened in both groups on the fifth day after surgery and take rate assessed. The donor site was assessed on day ten and if not healed, followed up for three weeks.Results: There was a statistically significant association between skin graft take rate and skin grafting technique (p=0.011). The mean graft take rate was 2.5% higher in the tumescent group compared to the non-tumescent group (96.3% compared to 94%). On day 10, there was no difference in percentage healing of donor sites between the tumescent and non-tumescent groups, p=0.562.Conclusions: Tumescent technique significantly reduced intraoperative blood loss. It is safe, inexpensive and easy to use. The subdermal adrenaline/saline injection creates a smooth, dense surface which assists debridement and donor harvesting.

scholarly journals Surgical Outcome in Tumescent and Non-Tumescent Method of Harvesting Split Skin Graft - An Observational Study at KR Hospital, Mysuru

2021 ◽  
Vol 8 (26) ◽  
pp. 2322-2327
Author(s):  
Anandaravi B.N. ◽  
Manjunath R.D. ◽  
Puneeth D.N
Keyword(s):  
Observational Study ◽  
Skin Graft ◽  
Local Anaesthesia ◽  
Split Skin Graft ◽  
Tumescent Technique ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Group A ◽  
Group B ◽  
Split Skin

BACKGROUND The study was started with the aim to determine take up rate in tumescent technique compared to non-tumescent technique for harvesting split skin graft. Tumescent technique has been practiced for over forty years especially in liposuction. Tumescent anaesthesia is a combination of crystalloid, lignocaine, adrenaline and sodium bicarbonate. Using tumescent local anaesthesia for harvesting a split thickness skin graft is not in much practise. This study was designed to provide strong evidence of this technique. METHODS This was an observational study. Two treatment groups of patients, tumescent (group A, N = 21) and non-tumescent technique (group B, N =21), who fulfilled the inclusion criteria were randomly assigned. Tumescent technique involved administration of Klein’s formula. No prior administration of agent was performed in non-tumescent technique. The recipient site was opened in both groups on the fifth day after surgery and take rate assessed. RESULTS The difference in take up rate between the two groups was found to be statistically significant. Compared to the patients in group B, patients who underwent tumescent technique (group A) had higher take up rate (> 12 %, P = 0.005). We did not find any statistically significant difference in donor site percentage healing between the tumescent and non-tumescent groups, P = 0.379. CONCLUSIONS Tumescent technique gives better take up results and is more effective than nontumescent technique in harvesting split skin graft. The subdermal injection creates a smooth, dense surface which assists donor harvesting. This can be implemented preoperatively in split-thickness skin grafting. KEYWORDS Split Skin Graft, Take Up Rate, Harvesting, Tumescent, Non-Tumescent, Local Anaesthesia

scholarly journals Regrafting of the Split-Thickness Skin Graft Donor-Site: Is It Beneficial?

2019 ◽  
Author(s):  
Catherine M Legemate ◽  
Ymke Lucas ◽  
Irma M M H Oen ◽  
Cornelis H Van Der Vlies
Keyword(s):  
Skin Graft ◽  
Donor Site ◽  
Skin Grafting ◽  
Split Thickness Skin Graft ◽  
Split Skin Graft ◽  
Thickness Skin ◽  
Split Skin Grafting ◽  
Split Thickness Skin Grafting ◽  
Graft Donor ◽  
Split Skin

Abstract Split-thickness skin grafting remains a fundamental treatment for patients with deep burns and other traumatic injuries. Unfortunately, the donor site wound that remains after split skin graft (SSG) harvesting may also cause problems for the patient; they can lead to discomfort and scars with a poor cosmetic outcome. Regrafting of the donor site is one of the methods described to improve donor site healing and scarring. In this report, we describe a case of a 26-year-old woman with a self-inflicted chemical burn (0.5% TBSA) who underwent split skin grafting. During surgery, only part of the donor site was regrafted with split skin graft remnants. This part healed faster and had a better scar quality at 3 months postsurgery. Nevertheless, the appearance and patients’ opinion on the regrafted part deteriorated after 12 months. With this case report, we aim to create awareness of the long-term consequences of regrafting, which may differ from short-time results. Patients expected to have poor reepithelialization potential may benefit from regrafting of the SSG on the donor site. But in healthy young individuals, timewise there would be no benefit since it can lead to an aesthetically displeasing result.

Efficacy of two-stage Meek micrografting in patients with severe burns

2021 ◽  
Author(s):  
Gaozhong Hu ◽  
Peng Zhang ◽  
Yan Chen ◽  
Zhiqiang Yuan ◽  
Huapei Song
Keyword(s):  
Survival Rate ◽  
Skin Graft ◽  
Laboratory Data ◽  
Length Of Hospital Stay ◽  
Skin Grafting ◽  
Two Stage ◽  
Cumulative Survival ◽  
Severe Burns ◽  
Group A ◽  
Group B

Abstract Background Burns are common injuries associated with high disability and mortality. In recent years, Meek micrografting technique has been gradually applied for the wound treatment of severe burns. However, the efficacy of two-stage Meek micrografting in patients with severe burns keeps unclear. Methods The data of eligible patients with severe burns who were admitted to Southwest Hospital of the Third Military Medical University from January 2013 to December 2019 were retrospectively analysed. The patients were divided into two groups according to the Meek micrografting method: one-stage skin grafting (group A) and two-stage skin grafting (group B). The baseline data, survival rate of skin graft, length of hospital stay, treatment costs, laboratory data and cumulative survival were statistically analysed. Results 127 patients (91 in group A and 36 in group B) were included in the study. There were no significant difference in the baseline data, the length of hospital stay and treatment costs between the two groups. The survival rate of skin graft was higher in group B. Total protein and albumin level, platelet count in group B were superior to those in group A, while there were no difference in other laboratory data (prealbumin, serum creatinine, urea nitrogen, cystatin C, blood cultures, wound exudate cultures) and cumulative survival between the two groups. Conclusion Our results demonstrated that staged Meek micrografting could improve the survival rate of skin graft, by reducing the risks of hypoproteinaemia, hypoalbuminemia and low platelet counts after adequate resuscitation.

Full Thickness Skin Graft for Nail Unit Reconstruction

2005 ◽  
Vol 30 (2) ◽  
pp. 194-198 ◽  
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.

scholarly journals Hyperpigmentation after surgery for a deep dermal burn of the dorsum of the hand: partial-thickness debridement followed by medium split-thickness skin grafting vs full-thickness debridement followed by thick split-thickness skin grafting

2016 ◽  
Vol 4 ◽  
pp. 1-11 ◽  
Author(s):  
Yoshitaka Kubota ◽  
Nobuyuki Mitsukawa ◽  
Kumiko Chuma ◽  
Shinsuke Akita ◽  
Yoshitaro Sasahara ◽  
...  
Keyword(s):  
Skin Graft ◽  
Skin Grafting ◽  
Japanese Patients ◽  
Interquartile Range ◽  
Split Thickness Skin Graft ◽  
Full Thickness ◽  
Color Spaces ◽  
Partial Thickness ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Abstract Background Early excision and skin grafting are commonly used to treat deep dermal burns (DDBs) of the dorsum of the hand. Partial-thickness debridement (PTD) is one of the most commonly used procedures for the excision of burned tissue of the dorsum of the hand. In contrast, full-thickness debridement (FTD) has also been reported. However, it is unclear whether PTD or FTD is better. Methods In this hospital-based retrospective study, we compared the outcomes of PTD followed by a medium split-thickness skin graft (STSG) with FTD followed by a thick STSG to treat a DDB of the dorsum of the hand in Japanese patients. To evaluate postoperative pigmentation of the skin graft, quantitative analyses were performed using the red, green, and blue (RGB) and the hue, saturation, and brightness (HSB) color spaces. We have organized the manuscript in a manner compliant with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Results Data from 11 patients were analyzed. Six hands (five patients) received grafts in the PTD group and eight hands (six patients) received grafts in the FTD group. Graft take was significantly better in the FTD group (median 98 %, interquartile range 95–99) than in the PTD group (median 90 %, interquartile range 85–90) (P &lt; 0.01). Quantitative skin color analyses in both the RGB and HSB color spaces showed that postoperative grafted skin was significantly darker than the adjacent control area in the PTD group, but not in the FTD group. Conclusions There is a possibility that FTD followed by a thick STSG is an option that can reduce the risk of hyperpigmentation after surgery for DDB of the dorsum of the hand in Japanese patients. Further investigation is needed to clarify whether the FTD or the thick STSG or both are the factor for the control of hyperpigmentation.

Minced skin grafting for promoting epithelialization of the donor site after split-thickness skin grafting

Burns ◽  
2017 ◽  
Vol 43 (4) ◽  
pp. 819-823 ◽  
Author(s):  
Toru Miyanaga ◽  
Yasuo Haseda ◽  
Akihiko Sakagami
Keyword(s):  
Donor Site ◽  
Skin Grafting ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

scholarly journals A systematic review of the scalp donor site for split-thickness skin grafting

2020 ◽  
Vol 47 (6) ◽  
pp. 528-534
Author(s):  
Suk Joon Oh
Keyword(s):  
Donor Site ◽  
Age Distribution ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Late Complications ◽  
Total Rate ◽  
Thickness Skin ◽  
Pubmed Database ◽  
Split Thickness Skin Grafting ◽  
Scalp Skin

Split-thickness skin grafting (STSG) is the gold standard for coverage of acute burns and reconstructive wounds. However, the choice of the donor site for STSG varies among surgeons, and the scalp represents a relatively under-utilized donor site. Understanding the validity of potential risks will assist in optimizing wound management. A comprehensive literature search was conducted of the PubMed database to identify studies evaluating scalp skin grafting in human subjects published between January 1, 1964 and December 31, 2019. Data were collected on early and late complications at the scalp donor site. In total, 27 articles comparing scalp donor site complications were included. The selected studies included analyses of acute burn patients only (21 of 27 articles), mean total body surface area (20 of 27), age distribution (22 of 27), sex (12 of 27), ethnicity (5 of 27), tumescent technique (21 of 27), depth setting of the dermatome (24 of 27), number of harvests (20 of 27), mean days of epithelization (18 of 27), and early and late complications (27 of 27). The total rate of early complications was 3.82% (117 of 3,062 patients). The total rate of late complications was 5.19% (159 of 3,062 patients). The literature on scalp skin grafting has not yet identified an ideal surgical technique for preventing donor site complications. Although scalp skin grafting provided superior outcomes with fewer donor site complications, there continues to be a lack of standardization. The use of scalp donor sites for STSG can prevent early and late complications if proper surgical planning, procedures, and postoperative care are performed.

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