Dermo traction as a solution to major skin defects: a prospective study in a tertiary care hospital of South Odisha

Background: Soft tissue loss with exposure of underlying tissue is a challenge to all Orthopedics surgeons. The present prospective study described dermo-traction technique using infant feeding tube or prolene suture as an alternative method for the wound closure.Methods: This prospective study described 30 cases where dermo-traction technique was used for the closure of the wound using infant feeding tube or prolene suture. Study was conducted in Orthopaedics Department of MKCG Medical College, Berhampur from June 2016 to May 2018. Patients requiring skin grafting for their major soft tissue defects or in whom skin grafting or fasciocutaneous flap could not be done were included in study.Results: Out of 30 patients, 2 were lost to follow-up. Average age of study participants was 39.1 years. Male constituted 67.8%. 78.5% of patients had wound in leg, 14.3% in thigh region, rest had on ankle. 82.1% had an open fracture wound, 10.7% had post-operative wound dehiscence and 7.1% soft tissue injury. Average wound healing time was 15.3days with average 5 tightening session of suture. Wounds healed eventually in 26 patients and 2 patients had an infection. Among 26 patients 9 patients had delayed primary and 17 had secondary closure of wound.Conclusions: It can be concluded that gradual closure of the wounds with soft tissue defects can be achieved by applying dermo-traction technique using prolene suture or infant feeding tube with average 15 days of time. So dermo-traction using infant feeding tube or prolene suture is a simple, inexpensive, effective and technically sound alternate solution for closure of wound.

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MANAGEMENT OF ACQUIRED SOFT TISSUE DEFECTS OF GROIN AND GENITALIA

10.36106/ijar/8407935 ◽

2020 ◽

pp. 1-4

Author(s):

Ratnakar Sharma ◽

Mir Adnan Samad ◽

Kumar Sourav Dogra ◽

Shaarang Gupta

Keyword(s):

Soft Tissue ◽

Road Traffic ◽

Past History ◽

Skin Grafting ◽

Soft Tissue Defects ◽

Detailed History ◽

Flap Coverage ◽

Split Thickness Skin Grafting ◽

History Of ◽

Tissue Defects

Background: The defects of the groin and the genitalia are complex and pose a challenge to the reconstructive surgeon. These defects may arise out of a variety of insults which include – extirpative oncologic surgeries, necrotizing fasciitis, post burn defects, post traumatic defects including road traffic accidents and animal bites etc. Objectives: To study the epidemiology of the acquired soft tissue defects of the groin and genitalia. To evaluate the role of various reconstructive modalities for the acquired soft tissue defects of groin and genitalia. Materials & Methods: This study was conducted in the Department of Surgery, Govt. Medical College Jammu, J&K, India and included 25 patients admitted with acquired soft-tissue defects of groin and genitalia over a period extending from November 2018 to October 2019 (Prospective study). Personal and demographic data of the patient was noted. A detailed history regarding the cause of the defect along with history of trauma, discharge and bleed from the site was taken. Any past history of surgery and irradiation of the region was noted. The patients having soft tissue defects of the groin and genitalia secondary to the release of post burn contracture were subjected to the detailed history as regards cause of burn, treatment taken and time taken for burn wounds to heal. Examination included general physical examination along with the local wound condition which included site, size, discharge, slough, granulation tissue and any exposed vital structures such as vessels/ nerves. A hemogram, assessment of blood sugar, renal function (blood urea nitrogen and serum creatinine), coagulation profile, blood grouping, viral markers, chest x-ray and ECG were done as a part of routine pre-operative investigations. Wound swab was sent for culture. Biopsy was taken wherever required. Analysis of report of any previously taken biopsy was done. Split thickness skin grafting was the modality of coverage utilized in 56% cases followed by flap coverage in 32% cases. 12% of the defects were closed primarily. Results: Majority of the patients had durable coverage of the defects of groin/genitalia and the coverage modality was acceptable to the patient as regards aesthesis and functional outcome. No major complication was encountered in any of the patients. Conclusion: The reconstruction of the soft tissue defects of groin and genitalia need a meticulous examination and planning of reconstructive modality which may include skin grafting or a flap coverage.

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Extracellular matrix graft for reconstruction over exposed structures: a pilot case series

Journal of Wound Care ◽

10.12968/jowc.2020.29.12.742 ◽

2020 ◽

Vol 29 (12) ◽

pp. 742-749

Author(s):

Gregory A Bohn ◽

Abigail E Chaffin

Keyword(s):

Extracellular Matrix ◽

Soft Tissue ◽

Skin Graft ◽

Granulation Tissue ◽

Case Series ◽

Skin Grafting ◽

Soft Tissue Defects ◽

Dermal Matrix ◽

Dermal Matrices ◽

Tissue Defects

Objective: Soft tissue defects, especially those involving exposed vital structures, present a reconstructive challenge because poor vascularity of such defects typically makes immediate skin grafting unviable. Where flap procedures are inappropriate or not possible, dermal matrices represent an alternative reconstructive option for defects with denuded vital structures. With dermal matrices becoming increasingly available and technologically advanced, we evaluated an ovine-derived extracellular matrix graft in the reconstruction of complex soft tissue defects involving exposed vital structures. Method: Six cases of soft tissue defects exhibiting denuded vital structures underwent reconstruction using an ovine forestomach matrix graft as a dermal matrix. Grafts were fixed directly into defects for immediate coverage and subsequently temporised defects via granulation tissue formation for later skin graft or secondary closure. Defect granulation and epithelialisation were monitored until closure and the final aesthetic and functional outcomes were evaluated. Results: Complete healing was achieved in all cases, with defect granulation becoming observable within one to two weeks and complete granulation occurring within one to six weeks. Granulation tissue resulting from the graft was suitable for skin grafting, with 100% take of skin grafts after one week and complete re-epithelialisation in two to three weeks in the four cases that received a skin graft. Good cosmetic, functional and patient satisfaction outcomes were achieved in all cases. Conclusion: The present series demonstrates our initial use of an extracellular matrix-based dermal matrix in reconstructing defects with exposed vital structures. While such dermal matrices do not supersede or replace flap procedures, they represent an alternative option on the reconstructive ladder in cases where flap procedures are not appropriate or possible.

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Reverse-Flow Intrinsic Fasciocutaneous Island Flaps in Foot Reconstruction

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734617740253 ◽

2017 ◽

Vol 16 (4) ◽

pp. 296-301

Author(s):

Sujin Bahk ◽

GyeongHyeon Doh ◽

Ki Yong Hong ◽

SooA Lim ◽

SuRak Eo

Keyword(s):

Soft Tissue ◽

Soft Tissues ◽

Reverse Flow ◽

Donor Site ◽

Skin Grafting ◽

Soft Tissue Defects ◽

Satisfactory Outcome ◽

Split Thickness Skin Grafting ◽

Foot Reconstruction ◽

Tissue Defects

Reconstruction of soft tissue defects in the foot remains a challenge due to its specialized tissue for weightbearing and ambulation. Considering the principle of replacing “like with like,” adjacent soft tissues would be a best option for a donor site. Although several kinds of reverse-flow island flaps for the lower leg have been well described, intrinsic foot reverse flow flaps have been rarely reported. We describe 3 kinds of reverse-flow intrinsic fasciocutaneous flaps (RIFFs) for foot reconstruction. From September 2012 to August 2015, a retrospective study was done on case notes of all patients who had a RIFF for coverage of soft tissue defects within the foot following trauma or tumor ablation. A total of 7 patients were included in this study, with an average of 5 × 3.5 cm sized defects in the forefoot, second and third web space, and sole, which were reconstructed with RIFF. All flaps were well perfused and recovered excellent function of the foot with satisfactory aesthetics and minimal limitations in range of motion. However, one case showed a complication of venous congestion, due to remnant scar tissues, which resolved after medical leech application. Donor defects healed completely with split thickness skin grafting in all cases. Soft tissue defects within the foot were repaired successfully by RIFF. In spite of its technical challenges, it is a reliable one-stage procedure requiring no microsurgical anastomosis. Precise vascular evaluation of the reverse inflow has to be preceded for satisfactory outcome of RIFF.

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Management of traumatic soft tissue defects with dermal regeneration template: A prospective study

Injury ◽

10.1016/j.injury.2013.11.034 ◽

2014 ◽

Vol 45 (7) ◽

pp. 1042-1048 ◽

Cited By ~ 7

Author(s):

Jean-Maxime Alet ◽

Romain Weigert ◽

Jean-Claude Castede ◽

Vincent Casoli

Keyword(s):

Soft Tissue ◽

Prospective Study ◽

Soft Tissue Defects ◽

Dermal Regeneration Template ◽

Dermal Regeneration ◽

A Prospective Study ◽

Tissue Defects

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Treatment of children with skin and soft tissue defects of distal phalanges of the fingers

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic687 ◽

2020 ◽

Vol 10 (3) ◽

pp. 293-298

Author(s):

Sergey N. Berezutskii ◽

Alexey G. Pinigin

Keyword(s):

Blood Flow ◽

Soft Tissue ◽

Skin Grafting ◽

Point Of View ◽

Island Flap ◽

Soft Tissue Defects ◽

Number Of Children ◽

Neurovascular Pedicle ◽

The Right ◽

Tissue Defects

Introduction. This article discusses the relevance of performing organ-preserving operations for traumatic skin and soft tissue defects in children. The author analyzes the traditional types of skin grafting procedures and their application in children. From the authors' point of view, the most acceptable skin grafting method is a displaced island flap on a neurovascular pedicle with direct blood flow. Materials and methods. The operating technique of lifting a displaced island flap on a neurovascular pedicle with direct blood flow is shown. The features of its implementation, the number of children, and their distribution by groups are shown. From 2016 to 2019, 15 children with traumatic defects of the distal phalanges of the fingers were operated on in the microsurgical Department of the Khabarovsk KKB No. 2 using a displaced neurovascular island flap on the leg with direct blood flow. The children ranged in age from four to 14 years. The number of children and the frequency of damage to the right and left hands was approximately the same. Results. Positive results of using this technique in the Department of Microsurgery of KKB No. 2 are presented. In all cases, it was possible to close the existing defects with the primary closure of the donor defect simultaneously; Sensitivity was preserved in all operated children, and movements in the finger joints were almost complete. Discussion. This flap method has undeniable advantages, although it is quite time-consuming and requires microsurgical skills, techniques, and appropriate equipment. The proposed skin grafting results are encouraging and satisfying for both doctors and children with parents. Conclusions. The authors recommend this skin grafting method for traumatic defects of the distal phalanges of the fingers in children.

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LOCAL FLAPS AND SPLIT;

The Professional Medical Journal ◽

10.29309/tpmj/2012.19.05.2404 ◽

2012 ◽

Vol 19 (05) ◽

pp. 630-635

Author(s):

IRFAN ISHAQ ◽

AWAIS AHMAD ◽

GHULAM QADIR FYYAZ

Keyword(s):

Soft Tissue ◽

Skin Grafting ◽

Local Flap ◽

Sensory Deficit ◽

Local Flaps ◽

Soft Tissue Defects ◽

Flap Coverage ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Tissue Defects

Background: Two point discrimination (TPD).is the minimum distance between two stimulus points on the skin, which areperceived as distinct points, Among the two types of TPD i.e., static and dynamic, static two-point discrimination (STPD) is commonly used todetermine digital nerve integrity. Local flaps usually do well in maintaining sensibility of the covered area in terms of two point discrimination incontrast to s-plit thickness skin grafts (STSG). Objective: The objective of this study was to determine the frequency of sensory deficit in termsof TPD in STSG and local flaps for soft tissue defects of fingers after three months. Study design: It was a Quasi experimental study. Settings:Patients admitted in the indoor of Plastic surgery department, Services Hospital Lahore. Period: February 2009 to January 2010. Material andMethods: Thirty five patients underwent local flap coverage and other thirty five underwent split thickness skin grafting for soft tissue defects offingers depending upon nature of defect. Patients were followed up at 2, 4, 8 and 12 weeks. Results: The sensory deficit observed at the end of12th week post operatively was in 8.6% of the patients with local flap coverage (3 patients) and 45.7% of those with STSG (16 patients).Patients with no sensory deficit were 91.4% (32 patients) in the local flap coverage and 54.3% (19 patients) in the STSG at 12th week of followup. The relative ratio of sensory deficit in local flaps and STSG was 5 (>2). Conclusions: The results of this study show that Local flaps arebetter options in terms of TPD preservation as opposed to STSG for soft tissue defects of fingers.

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The Use of Negative-Pressure Therapy and Skin Grafting in the Treatment of Soft-Tissue Defects Over the Achilles Tendon

Annals of Plastic Surgery ◽

10.1097/01.sap.0000181342.25065.60 ◽

2005 ◽

Vol 55 (4) ◽

pp. 367-370 ◽

Cited By ~ 15

Author(s):

Remus Repta ◽

R Ford ◽

L Hoberman ◽

B Rechner

Keyword(s):

Soft Tissue ◽

Achilles Tendon ◽

Negative Pressure ◽

Skin Grafting ◽

Soft Tissue Defects ◽

Negative Pressure Therapy ◽

Pressure Therapy ◽

Tissue Defects

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Recording Congenital Differences of the Upper Limb

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(02)00299-1 ◽

2003 ◽

Vol 28 (3) ◽

pp. 205-214 ◽

Cited By ~ 17

Author(s):

A. J. M. LUIJSTERBURG ◽

G. J. SONNEVELD ◽

CHR. VERMEIJ-KEERS ◽

S. E. R. HOVIUS

Keyword(s):

Soft Tissue ◽

Prospective Study ◽

Upper Limb ◽

Soft Tissue Defects ◽

Recording Method ◽

A Prospective Study ◽

Tissue Defects

Consistent classification of congenital differences of the upper limb is of paramount importance for the study of the pathogenesis. To overcome the inconsistencies of present classifications, a non-classifying recording method has been developed. This method records individual aberrations, including bone and soft-tissue defects. Between 1996 and 1998, a prospective study was performed to validate the method. Two hundred and thirty-one patients with upper limb differences were assessed, and all individual aberrations were recorded. These data can be transferred to any classification. It is concluded that the presented method will allow consistent grouping of patients without losing details about simple and complex differences.

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