scholarly journals 2-Octyl Cyanoacrylate Glue Application on Split-Thickness Skin Graft for Lower Extremity Reconstruction

2021 ◽  
Vol 17 (3) ◽  
pp. 232-236
Author(s):  
Bu Hyeon Choi ◽  
Kyu Sang Cho ◽  
Jung Woo Chang ◽  
Jang Hyun Lee
Keyword(s):  
Lower Extremity ◽  
Skin Graft ◽  
Normal Skin ◽  
Wound Dehiscence ◽  
Split Thickness Skin Graft ◽  
Skin Defect ◽  
Cyanoacrylate Glue ◽  
Time Saving ◽  
Thickness Skin ◽  
Lower Extremity Reconstruction

A split-thickness skin graft (STSG) is a very effective method for reconstructing skin defects in the lower extremities; however, suturing all graft margins during surgery is time-consuming. As an alternative, 2-octyl cyanoacrylate glue attaches the epidermal layer of an STSG to normal skin and functions like a suture. In this study, we assessed 2-octyl cyanoacrylate glue as a time-saving step in STSG procedures. We reviewed the charts of 87 patients who underwent STSG between May 2018 and August 2020. For the 10 patients who consented to the STSG procedure with 2-octyl cyanoacrylate glue, we evaluated the treatment site for complications and engraftment every 2 days for 14 days. The STSGs were successfully engrafted in all cases. Seroma, hematoma, wound dehiscence, or infection were not documented. No additional revision surgery was required. The use of 2-octyl cyanoacrylate glue in STSG margin fixation was safe, effective, convenient, and time-saving. This study found 2-octyl cyanoacrylate glue a good option for lower extremity skin defect reconstruction.

scholarly journals Wound coverage of plantar metatarsal ulcers in leprosy using a toe web flap

2005 ◽  
Vol 38 (02) ◽  
pp. 123-127
Author(s):  
J Joshua ◽  
V Chakraborthy
Keyword(s):  
Skin Graft ◽  
Metatarsophalangeal Joint ◽  
Wound Dehiscence ◽  
Split Thickness Skin Graft ◽  
Wound Coverage ◽  
Thickness Skin ◽  
Secondary Defect ◽  
Metatarsophalangeal Joints

ABSTRACTPlantar metatarsal ulcers and sinuses are frequently seen problems in anaesthetic feet in leprosy. They may occur singly or as multiple sinuses. Many flaps have been described in the management of small defects of the forefoot. During the course of four years, from March 2000 to February 2004, a total of 708 plantar metatarsal ulcers in anaesthetic feet due to leprosy were seen. 280 surgeries were performed on 257 cases. Most of these were debridement and or excision of the metatarsophalangeal joints through a dorsal incision. Thirteen cases were dealt with by a toe web flap, using the plantar metatarsal artery as the source of supply to the flap. Nine were to cover defects under the 1st metatarsophalangeal joint. Three were to cover defects under the second and third metatarsophalangeal joints and one involved coverage of a defect under the 5th metatarsophalangeal joint. In all cases except the last, the big toe contributed the flap. In the last case the fourth toe was the donor. In all cases the flaps survived and did well. The secondary defects were covered with split thickness skin graft. Wound dehiscence was seen in one case and recurrence of a sinus, was seen in one case. Hyperkeratosis of the secondary defect was seen in three cases. Follow up ranged from 3 years to six months. We found this flap to be durable and safe with little chance of recurrence when used to cover plantar metatarsal ulcers.

scholarly journals An analysis of post traumatic leg and foot defects

2019 ◽  
Vol 6 (6) ◽  
pp. 2041
Author(s):  
Gopalan G. ◽  
Dhanaraju S.
Keyword(s):  
Soft Tissue ◽  
Skin Graft ◽  
Traffic Accidents ◽  
Lower Limbs ◽  
Split Thickness Skin Graft ◽  
Soft Tissue Coverage ◽  
Durable Good ◽  
Skin Defect ◽  
Early Recovery ◽  
Thickness Skin

Background: Management of lower extremity trauma with bone and soft tissue injury is a challenging task with the aim of giving early recovery and durable good quality skin cover according to the skin defect and analyze various reconstructive options at various levels of injury. Our aim of the study is to analyze various reconstructive options for traumatic skin loss involving lower limbs especially knee and below knee, and analyze the incidence of age, sex and etiology of traumatic defects.Methods: Prospective study in our plastic surgery department in the period of 24 months, with all the cases of traumatic defects of leg and foot where included. All age and sex patients were included.Results: Most common cause for traumatic leg and foot defects are road traffic accidents followed by accidental fall and others, most commonly in males amounting 73%, children 10% and  females 17%, among the skin and soft tissue  defects upper and lower 1/3 leg defects are predominant. Among the soft tissue coverage split thickness skin graft dominating about 60% of cases, flaps 30% of cases, among the flaps 70% are fasciocutaneous flaps predominantly inferiorly based  and 30% are muscle and musculocutaneous flaps, among the muscle predominantly soleus muscle flap was used to cover the defect.Conclusions:Road traffic accidents dominating the cause for leg and foot defects , males are more commonly affected  and upper one third leg defects are predominant for soft tissue coverage split thickness skin graft are commonest procedures followed that cutaneous and muscle flaps. 

scholarly journals Reconstruction of Pretibial Defect Using Bone-Anchored Advancement Flap

2021 ◽  
Vol 17 (1) ◽  
pp. 72-75
Author(s):  
Suhwan Kim ◽  
Kyeong-Tae Lee ◽  
Jin-Woo Park
Keyword(s):  
Skin Graft ◽  
Free Flaps ◽  
Advancement Flap ◽  
Split Thickness Skin Graft ◽  
Skin Defect ◽  
Major Drawback ◽  
Medial Side ◽  
Thickness Skin ◽  
Extended Operation ◽  
One Year

While free flaps have been widely used for reconstruction of pretibial defects, the extended operation times are known to be a major drawback. This report presents a case of successful lower leg reconstruction for a large pretibial defect with a bone-anchored advancement flap and split-thickness skin graft. A 59-year-old female patient underwent wide excision of sarcoma on the pretibial area. The skin defect measured 14×6 cm with a 10×2 cm exposure of the tibia in the medial aspect of the defect. An advancement flap was elevated from the medial side of the tibia to cover the exposed bone. The bone defect was reconstructed by the advancement flap with the aid of an anchoring suture to the tibia. Remaining defect with exposed muscles was covered using split-thickness skin graft. No immediate postoperative complication developed. One year after the operation, well-contoured reconstruction was achieved without functional morbidities. In reconstruction of pretibial defects, bone-anchored advancement flap can be considered in patients who are reluctant to or have risk factors for free flap reconstruction.

scholarly journals Efficacy of autologous platelet rich plasma over conventional mechanical fixation methods in split thickness skin grafting

2018 ◽  
Vol 6 (1) ◽  
pp. 108 ◽  
Author(s):  
Girish Umashankar Thimmanahalli ◽  
Mahesh Kumar
Keyword(s):  
Skin Graft ◽  
Platelet Rich Plasma ◽  
Healing Process ◽  
Split Thickness Skin Graft ◽  
Skin Defect ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Autologous Platelet Rich Plasma ◽  
Graft Reconstruction ◽  
Autologous Platelet

Background: Platelet-Rich Plasma (PRP) is an autologous product derived from whole blood through the process of gradient density centrifugation. After skin graft reconstruction, the healing process is longer and may be difficult, depending on the wound site, skin defect size, and patient comorbidities. The potential value of PRP lies in its ability to incorporate high concentrations of platelet-derived growth factors into the skin graft. Since not all patients afford commercially available recombinant platelet rich plasma for skin graft, platelet extract from patient’s own blood is being used in this study to test and demonstrate the therapeutic role of PRP in skin graft. The aim of this randomized, prospective study is to compare the effectiveness of PRP in skin graft with conventional method like sutures, staplers or glue.Methods: The source of data were the patients admitted as inpatients for the management of wounds to the department of general surgery, JSS Hospital, Mysore from September 2016 to September 2018. Total of 60 patients were studied; 30 cases were randomly chosen for study with autologous platelet rich plasma and 30 cases received conventional methods like staples/sutures used to anchor the skin grafts in a control group.Results: Autologous PRP showed faster and better healing rates. With PRP study group instant graft adherence was seen in all cases. Hematoma, graft edema, discharge from graft site, frequency of dressings and duration of stay in hospital were significantly less in the PRP. There were no adverse effects or reactions seen with the use of autologous PRP among the study group.Conclusions: The combination of PRP with Split Thickness Skin Graft (STSG) significantly improved clinical outcomes and shortened the wound healing time. Therefore, this treatment combination could provide a way to heal skin after skin graft reconstruction with minimal recovery time. It is found to be highly beneficial in many aspects both to the patient and surgeon based on our results.

scholarly journals Esterified Hyaluronic Acid Matrix in Lower Extremity Reconstruction With Exposed Tendon and Bone: A Retrospective Review

2020 ◽  
Vol 41 (4) ◽  
pp. 828-834
Author(s):  
Steven D Kozusko ◽  
Mahmoud Hassouba ◽  
David M Hill ◽  
Xiangxia Liu ◽  
Kalyan Dadireddy ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Lower Extremity ◽  
Tissue Regeneration ◽  
Skin Graft ◽  
Endothelial Cell Migration ◽  
Split Thickness Skin Graft ◽  
Novel Technologies ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Exposed Bone

Abstract Lower extremity wounds with exposed bone and tendon often need coverage to allow the underlying tissue to regenerate prior to skin graft. The surgeon is limited in his or her choices to augment tissue regeneration in these types of complicated cases; for instance, autologous skin should not be placed on exposed bone or tendon and is at risk for contracture when placed over the joints. Therefore, novel technologies are necessary to provide a scaffolding for tissue to regenerate and allow for a successful graft. One such technology is an esterified hyaluronic acid matrix (eHAM), which can provide a proper scaffold for endothelial cell migration and aid in angiogenesis. The eHAM is made of two layers: a layer of hyaluronic acid covered with a silicone layer. In this retrospective chart review, we describe our usage of eHAM to provide scaffolding for tissue regeneration prior to grafting in 15 cases of complicated lower extremity wounds with exposed bone and tendon. The average patient age was 45.8 years, and all patients had multiple medical comorbidities, such as poorly controlled diabetes mellitus, hypertension, and nicotine addiction. Patient wound types were diverse, including traumatic wounds, chronic diabetic foot ulcers, and thermal or electric burns. Thirteen of the 15 cases were treated successfully with eHAM. In these cases, definitive coverage with split-thickness skin grafting was effective and limb salvage was successful. In the 13 successful cases, the mean time to split-thickness skin graft was 22.9 ± 7.0 days. All patients continue to do well at follow-up (ranging from 6 to 48 weeks), with minimal complications reported. Given the success rate with eHAM in this challenging population, we conclude that eHAM can be a treatment option for similar cases.

scholarly journals Wound closure expectations after fasciotomy for paediatric compartment syndrome

2018 ◽  
Vol 12 (1) ◽  
pp. 9-14 ◽  
Author(s):  
E. D. Shirley ◽  
V. Mai ◽  
K. M. Neal ◽  
G. M. Kiebzak
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Upper Extremity ◽  
Skin Graft ◽  
Wound Closure ◽  
Acute Compartment Syndrome ◽  
Split Thickness Skin Graft ◽  
Paediatric Patients ◽  
Thickness Skin ◽  
Additional Surgery

Purpose Acute compartment syndrome often requires additional surgery to achieve wound closure. Little information exists regarding the expected number of surgeries, techniques and complications after closure in paediatric patients. Methods A retrospective chart review identified patients treated for acute compartment syndrome at four hospitals over a ten-year period. The cause of injury, type of dressing, number of surgeries, type of closure and complications were recorded. Results In all, 32 patients (mean 10.9 years, 1 to 17) who underwent 18 lower and 14 upper extremity fasciotomies met inclusion criteria. Definitive wound closure technique was delayed primary in 72%, split thickness skin graft in 25%, and primary in 3% of patients. Closure required a mean 2.4 surgeries (0 to 4) over a mean 7.7 days (0 to 34). Days to closure and number of surgeries required were not significantly affected by mechanism of injury, fasciotomy location or type of dressing used. A total of 23.1% of patients with upper extremity and 0% with lower extremity fasciotomies had concerns about the scar appearance. Other complications included neurapraxia (6.7%), stiffness (6.7%), swelling (3.3%), scar pain (3.3%) and weakness (3.3%). Conclusions The most common complication after paediatric compartment syndrome is an unpleasant scar. Wound closure after upper or lower extremity fasciotomies in paediatric patients requires a split thickness skin graft in approximately one in four patients. However, avoiding a skin graft does not guarantee the absence of cosmetic concerns, which are more likely following upper extremity fasciotomies. Level of Evidence IV

Improving Outcomes in Anterolateral Thigh Flap Donor-Site Reconstruction Using Propeller Flaps: A Retrospective Comparative Study with Skin Grafting

2020 ◽  
Author(s):  
Domenico Pagliara ◽  
Maria Lucia Mangialardi ◽  
Stefano Vitagliano ◽  
Valentina Pino ◽  
Marzia Salgarello
Keyword(s):  
Comparative Study ◽  
Skin Graft ◽  
Donor Site ◽  
Split Thickness Skin Graft ◽  
Tactile Sensitivity ◽  
Aesthetic Outcome ◽  
Propeller Flap ◽  
Thickness Skin ◽  
Anterolateral Thigh ◽  
Alt Flap

Abstract Background After anterolateral thigh (ALT) flap harvesting, skin graft of the donor site is commonly performed. When the defect width exceeds 8 cm or 16% of thigh circumference, it can determine lower limb function impairment and poor aesthetic outcomes. In our comparative study, we assessed the functional and aesthetic outcomes related to ALT donor-site closure with split-thickness skin graft compared with thigh propeller flap. Methods We enrolled 60 patients with ALT flap donor sites. We considered two groups of ALT donor-site reconstructions: graft group (30 patients) with split-thickness skin graft and flap group (30 patients) with local perforator-based propeller flap. We assessed for each patient the range of motion (ROM) at the hip and knee, tension, numbness, paresthesia, tactile sensitivity, and gait. Regarding the impact on daily life activities, patients completed the lower extremity functional scale (LEFS) questionnaire. Patient satisfaction for aesthetic outcome was obtained with a 5-point Likert scale (from very poor to excellent). Results In the propeller flap group, the ROMs of hip and knee and the LEFS score were significantly higher. At 12-month follow-up, in the graft group, 23 patients reported tension, 19 numbness, 16 paresthesia, 22 reduction of tactile sensitivity, and 5 alteration of gait versus only 5 patients experienced paresthesia and 7 reduction of tactile sensitivity in the propeller flap group. The satisfaction for aesthetic outcome was significantly higher in the propeller flap group. Conclusion In high-tension ALT donor-site closure, the propeller perforator flap should always be considered to avoid split-thickness skin graft with related functional and aesthetic poor results.

Sign in / Sign up

Export Citation Format

Share Document