Reconstruction of post burns facial contractures and deformities: an Indian perspective

Background: Reconstruction of facial burns contracture is one of the most important surgeries in cosmetic and reconstructive surgery. This study was aimed to assess the different modalities used in facial reconstruction and their outcome.Methods: This retrospective study involved 20 patients with extensive burning facial scars. Patients were treated with different reconstructive modalities like split/full thickness skin grafts or flaps etc. Outcome of different modalities as per the area of face involved, graft taken up and complications were analyzed.Results: Majority patients were of age between 20-30 years. 72.22% patients had other associated burn injuries with facial involvement. Most patients (18, 90%) were treated after 9 months post burns duration. All patients had multiregional involvement on face but cheek being the largest unit, was most commonly involved (18, 90%) followed by involvement of oral commissure and lips in 8 (40%) and orbital region in 7 (35%) patients. Full thickness skin graft (FTSG) and split thickness skin grafts (STSG) were most commonly performed procedures. Patient with forehead scarring was treated with abdominal tube transferred in stages. Two patients with eyelid ectropion treated with release and STSG. Gillies up and down forehead flap were used for nose reconstruction due to non-availability of tissue expanders. Linear scars on chick not fitting in relaxed skin tension line were treated with excision and primary “z” plasty. Hypertrophic scar of ear was excised and STSG was applied. Common complications included hyperpigmentation and hypopigmentation, contour distortion and obliteration of labiomental sulcus.Conclusions: Facial reconstructive procedure for burns scars should be selected based on region of face involved. Skin grafting is an effective method for reconstruction especially in areas with non-availability of advanced treatment modalities.

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Skin Grafting

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0007 ◽

2019 ◽

pp. 65-72

Author(s):

Stephen M. Milner

Keyword(s):

Skin Grafting ◽

Skin Grafts ◽

Full Thickness ◽

Preoperative Preparation ◽

Scar Contracture ◽

Skin Defects ◽

Full Thickness Skin ◽

Thickness Skin ◽

Contracture Release

Skin grafting is an indispensable technique used in a variety of clinical situations, including acute burns, traumatic wounds, scar contracture release, and oncological and congenital deficiencies. The author’s preferred techniques for harvesting and resurfacing various skin defects using split- and full-thickness skin grafts are described in this chapter, together with the assessment of donor and recipient sites, preoperative preparation and postoperative considerations.

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Tie-Over Bolster Dressings vs Basting Sutures for the Closure of Full-Thickness Skin Grafts: A Review of the Literature

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475418782152 ◽

2018 ◽

Vol 22 (6) ◽

pp. 602-606 ◽

Cited By ~ 6

Author(s):

William Kromka ◽

Michael Cameron ◽

Ramin Fathi

Keyword(s):

Skin Grafting ◽

Skin Grafts ◽

Full Thickness ◽

Review Of The Literature ◽

Advantages And Disadvantages ◽

Full Thickness Skin ◽

Improved Outcomes ◽

Thickness Skin ◽

Wide Range ◽

Cosmetic Outcomes

Background: Full-thickness skin grafting is a well-established technique in the reconstruction of various tissue defects and wounds. However, lack of uniformity in the procedure of closing and securing the grafts has led to a wide range of different techniques. Objective: This article reviews the use of tie-over bolster dressings compared to basting sutures for the fixation and postsurgical immobilization of full-thickness skin grafts (FTSGs), discusses details of each method, and proposes a practice guideline for the closure of FTSGs. Methods: A traditional review of the literature was performed through a search of PubMed using the following keywords: full-thickness skin graft, FTSG, closure, suture, tie-over bolster, quilting, and bolster. Results: The current literature regarding tie-over bolster dressings does not demonstrate improved outcomes compared to quilting sutures. The 2 techniques appear equivalent in terms of utility and outcome, both possessing distinct advantages and disadvantages. Conclusion: Despite minimal head-to-head studies between tie-over bolsters and quilting, the best evidence from the literature appears to show comparable results regarding graft take, cosmetic outcomes, and postoperative complications. Ultimately, the choice of using a tie-over bolster technique or quilting sutures relies on surgeon preference and anatomic location.

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Full-Thickness Skin Grafts and Quilting Sutures for the Reconstruction of Internal Nasal Lining

Facial Plastic Surgery ◽

10.1055/s-0040-1713116 ◽

2020 ◽

Vol 36 (03) ◽

pp. 297-304

Author(s):

PD Dr. med. Antoniu-Oreste Gostian ◽

Dr. med. Matthias Balk ◽

Dr. med. Achim Stegmann ◽

Prof. Dr. med. Dr. h.c. Heinrich Iro ◽

Prof. Dr. med. Jochen Wurm

Keyword(s):

Skin Grafting ◽

Free Flaps ◽

Nasal Reconstruction ◽

Skin Grafts ◽

Full Thickness ◽

Forehead Flap ◽

Full Thickness Skin ◽

Nicotine Abuse ◽

Thickness Skin ◽

Feasible Option

AbstractRestoration of the inner nasal lining is an essential factor in successful nasal reconstruction. Among various methods, free full-thickness skin grafting represents a readily available and feasible technique. A prerequisite for success is a secure and immobile fixation to the undersurface of the nourishing forehead flap. This retrospective study aims to evaluate the results of multiple quilting sutures to secure free full-thickness skin grafts for the reconstruction of the inner nasal lining in partial and extended nasal reconstruction. Between February 1, 2015, and December 31 2018, 16 patients underwent three-stage nasal reconstruction of all three layers using a forehead flap. All full-thickness free flaps were harvested from either the neck or inguinal area and fixated to the undersurface of the distal part of the forehead flap by multiple quilting sutures. All but one free skin grafts healed well (seven ♀; mean: 63 years; range: 52–81). Four patients developed minor complications that resolved completely through conservative treatment. One patient with a history of stroke, extensive nicotine abuse, and arterial hypertension developed flap necrosis that required two surgical revisions and ended up with a stenosis of the left nostril. The follow-up time averaged 18.4 months (range: 3–55 months). Multiple quilting sutures are an effective and feasible option to fixate full-thickness free skin grafts on the undersurface of the forehead flap for the reconstruction of the inner nasal lining. They are not associated with increased risks for necrosis and can be applied even to extended full-thickness nasal defects in selected cases.

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One-step approach for full-thickness skin defect reconstruction in rats using minced split-thickness skin grafts with Pelnac overlay

Burns & Trauma ◽

10.1186/s41038-019-0157-0 ◽

2019 ◽

Vol 7 ◽

Cited By ~ 2

Author(s):

Tong Liu ◽

Chao Qiu ◽

Chi Ben ◽

Haihang Li ◽

Shihui Zhu

Keyword(s):

Wound Healing ◽

Healing Rate ◽

Skin Grafting ◽

Skin Defect ◽

Skin Grafts ◽

Full Thickness ◽

Full Thickness Skin ◽

Thickness Skin ◽

Split Thickness Skin Grafting

Abstract Background Split-thickness skin grafting is the current gold standard for the treatment of traumatic skin loss. However, for patients with extensive burns, split-thickness skin grafting is limited by donor skin availability. Grafting split-thickness skin minced into micrografts increases the expansion ratio but may reduce wound repair quality. Dermal substitutes such as Pelnac can enhance the healing of full-thickness skin wounds, but their application currently requires two surgeries. The present study investigated whether it is possible to repair full-thickness skin defects and improve wound healing quality in a single surgery using Pelnac as an overlay of minced split-thickness skin grafts in a rat model. Methods A full-thickness skin defect model was established using male Sprague-Dawley rats of 10 weeks old. The animals were randomly divided into control and experimental groups in which Vaseline gauze and Pelnac, respectively, were overlaid on minced split-thickness skin grafts to repair the defects. Wound healing rate and quality were compared between the two groups. For better illustration of the quality of wound healing, some results were compared with those obtained for normal skin of rats. Results We found that using Pelnac as an overlay for minced split-thickness skin grafts accelerated wound closure and stimulated cell proliferation and tissue angiogenesis. In addition, this approach enhanced collagen synthesis and increased the formation of basement membrane and dermis as well as the expression of growth factors related to wound healing while reducing scar formation. Conclusions Using minced split-thickness skin grafts overlaid with Pelnac enables the reconstruction of full-thickness skin defects in a single step and can increase the healing rate while improving the quality of wound healing.

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Outcomes of split vs full-thickness skin grafts in scalp reconstruction in outpatient local anaesthetic theatre

Scars Burns & Healing ◽

10.1177/20595131211056542 ◽

2021 ◽

Vol 7 ◽

pp. 205951312110565

Author(s):

Luxi Sun ◽

Animesh JK Patel

Keyword(s):

Skin Graft ◽

Local Anaesthetic ◽

Skin Grafting ◽

Skin Grafts ◽

Full Thickness ◽

Full Thickness Skin ◽

Graft Take ◽

Thickness Skin ◽

Graft Reconstruction ◽

Scalp Skin

Background Surgical excision remains the cornerstone of simultaneous diagnosis and treatment of suspicious skin lesions, and the scalp is a high-risk area for skin cancers due to increased cumulative lifetime ultraviolet (UV) exposure. Due to the inelasticity of scalp skin, most excisions with predetermined margins require reconstruction with skin grafting. Methods A retrospective single-centre cohort study was performed of all patients undergoing outpatient local anaesthetic scalp skin excision and skin graft reconstruction in the Plastic Surgery Department at Addenbrookes Hospital over a 20-month period between 1 April 2017 and 1 January 2019. In total, 204 graft cases were collected. Graft reconstruction techniques included both full-thickness and split-thickness skin grafts. Statistical analysis using Z tests were used to determine which skin grafting technique achieved better graft take. Results Split-thickness skin grafts had a statistically significant ( P = 0.01) increased average take (90%) compared to full-thickness skin grafts (72%). Using a foam tie-over dressing on the scalp led to a statistically significant ( P = 0.000036) increase in skin graft take, from 38% to 79%. Conclusion In skin graft reconstruction of scalp defects after skin cancer excision surgery, split skin grafts secured with foam tie-over dressings are associated with superior outcomes compared to full-thickness skin grafts or grafts secured with sutures only.

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