Solving Acne Inversa (Hidradenitis Suppurativa) in Crohn Disease with Buried Chip Skin Grafts

Background: Acne inversa is a progressive chronic inflammatory disease associated with abscess and fistula formation and subsequent scarring. In recent years, an increasing number of reports have been published about acne inversa and concomitantly occurring Crohn disease. Extensive anogenitoperineal soft tissue defects represent an enormous challenge to therapy. Common treatment strategies of reconstructive surgery such as local flaps, free flaps, or split-thickness skin grafts are frequently problematic and associated with poor outcomes. Objective: The aim of this case report is to demonstrate the clinical problem of extensive anogenitoperineal soft tissue defects and to present a surgical technique that can be successfully used in such difficult cases. Methods: In both cases, extensive excision of the affected areas was carried out down to the gluteal muscles followed by intramuscular grafting of buried skin chip grafts. Results: In both cases, the final postoperative results after numerous surgeries were very good, with complete wound closure resulting in complete recovery and social reintegration. Conclusion: The technique of buried skin chip grafting has long been ignored since split-thickness skin grafting and different techniques of flap coverage evolved, but it may constitute a highly efficient treatment strategy in challenging reconstructive situations.

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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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One-stage reconstruction of soft tissue defects with the sandwich technique: Collagen-elastin dermal template and skin grafts

Journal of Cutaneous and Aesthetic Surgery ◽

10.4103/0974-2077.91248 ◽

2011 ◽

Vol 4 (3) ◽

pp. 176 ◽

Cited By ~ 6

Author(s):

Uwe Wollina

Keyword(s):

Soft Tissue ◽

Skin Grafts ◽

Soft Tissue Defects ◽

Sandwich Technique ◽

One Stage ◽

One Stage Reconstruction ◽

Dermal Template ◽

Tissue Defects

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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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Reconstructive Outcomes of Extensive Soft-Tissue Defects after Palliative Mastectomy for Advanced Breast Cancer

Journal of Wound Management and Research ◽

10.22467/jwmr.2021.01795 ◽

2021 ◽

Vol 17 (3) ◽

pp. 169-177

Author(s):

Taekeun Yoon ◽

Soo Jin Woo ◽

Ung Sik Jin

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Soft Tissue ◽

Life Expectancy ◽

Split Thickness Skin Graft ◽

Tram Flap ◽

Soft Tissue Defects ◽

Thickness Skin ◽

Tissue Defects

Background: In advanced breast cancer, reconstruction can be performed depending on the patient’s situation, and can improve the subsequent treatment and quality of life. We examined the effect of reconstruction after palliative mastectomy on survival and quality of life.Methods: Between April 2010 and April 2021, 40 patients underwent reconstruction after palliative mastectomy for stage-IV breast cancer. To evaluate postoperative satisfaction, changes in the global health and quality-of-life scores after reconstruction were evaluated using questionnaires by the European Organisation for Research and Treatment of Cancer. The survival rate according to reconstructive surgery was estimated by the Kaplan-Meier survival analysis.Results: Reconstruction methods included free transverse rectus abdominis musculocutaneous (TRAM) flap (n=3), pedicled latissimus dorsi (LD) flap (n=3), pedicled TRAM flap (n=2), pedicled LD with pedicled vertical rectus abdominis musculocutaneous flap (n=1), tissue expander insertion (n=3), and split-thickness skin graft (n=28). There were no major complications or decreased life expectancy due to reconstruction. All patients healed well and started conventional chemoradiotherapy at 31.3 days postoperatively. The quality-of-life scores increased from 37 to 83 after reconstruction. There was no difference in the survival rates between those who underwent reconstruction with split-thickness skin graft and flap operation (P>0.05). The mean survival time postoperatively was 43.9 months.Conclusion: Compared to primary closure, reconstruction of extensive soft-tissue defects after palliative mastectomy did not affect life expectancy or delay postoperative chemoradiotherapy; it led to an improved quality of life. Therefore, the extensive defects expected after palliative mastectomy should not influence indications for reconstruction surgery.

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Reverse Posterior Interosseous Artery Flap: A Reliable, Comfortable and Versatile Flap for Coverage of Soft Tissue Defects of Hand

Journal of Wound Management and Research ◽

10.22467/jwmr.2020.01123 ◽

2020 ◽

Vol 16 (2) ◽

pp. 73-79

Author(s):

Mohammed Fahud Khurram ◽

Sudheer Kumar Maurya ◽

Mohd Yaseen ◽

Madhav Chowdhry

Keyword(s):

Soft Tissue ◽

Soft Tissue Defects ◽

Posterior Interosseous Artery ◽

Thickness Skin ◽

Hand Defects ◽

Interosseous Artery ◽

Posterior Interosseous Artery Flap ◽

Loupe Magnification ◽

Tissue Defects ◽

Entire Treatment

Background: Soft tissue defects of the hands require coverage with soft, pliable full-thickness skin. The posterior interosseous artery (PIA) flap fulfils all these requirements and also has significant advantages over other flaps; it is a single-stage procedure that does not sacrifice major vascular axis of the hand. However, the dissection can be challenging and requires meticulous skill. The objective of the study was to evaluate the reverse PIA flap for coverage of hand soft tissue defects in terms of its safety, reliability, comfort, function and aesthetic appearance.Methods: Over a period of 3 years, patients with soft tissue defects over the dorsum of the hand and first web space were observed. A standard PIA flap was raised using loupe magnification under general or brachial anesthesia. The size and location of the defect were noted along with the size and success of the flap.Results: Twelve patients, including nine males and three females, were taken up for this procedure. All the flaps survived completely except one with marginal necrosis not requiring a secondary procedure. All patients were quite satisfied with the procedure and went on to resume their work within a month or two.Conclusion: PIA flap is a safe, reliable option with great versatility for coverage of hand defects, especially over the dorsum. A well-planned flap surgery done under loupe magnification affords excellent results. The entire treatment also requires a shorter hospital stay and allows the patient to return to work quickly.

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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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Evaluation of Soft Tissue Defects' Reconstruction Using Flaps or Skin Grafts

Macedonian Journal of Medical Sciences ◽

10.3889/mjms.1857-5773.2009.0063 ◽

2009 ◽

Vol 2 (3) ◽

pp. 230-234

Author(s):

Elizabeta Mirchevska ◽

Igor Peev ◽

Margarita Peneva ◽

Boro Dzonov ◽

Marija Marchevska ◽

...

Keyword(s):

Soft Tissue ◽

Skin Grafts ◽

Soft Tissue Defects ◽

Tissue Defects

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A complex soft tissue reconstruction of distal phalanges in children

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic701 ◽

2021 ◽

Vol 11 (1) ◽

pp. 27-38

Author(s):

Alexander V. Alexandrov ◽

Pavel V. Goncharuk ◽

Lamiya Ya. Idris ◽

Vsevolod V. Rybchenok ◽

Alexander A. Smirnov

Keyword(s):

Soft Tissue ◽

Skin Graft ◽

Reverse Flow ◽

Island Flap ◽

Full Thickness ◽

Soft Tissue Defects ◽

Full Thickness Skin Graft ◽

Cold Intolerance ◽

Thickness Skin ◽

Tissue Defects

BACKGROUND: Injuries of distal phalanges are the most common type of hand trauma in children. The problem of coverage of soft tissue defects of distal phalanges remains. Many methods of coverage of distal phalanges defects have been developed. There is no generally accepted approach or an algorithm in treatment of adults and children with such type of trauma. AIM: This study aimed to reveal the most universal method of coverage of distal phalanges defects in children using various reconstruction methods that are used at the Department of Reconstructive Microsurgery of Filatov State Children Hospital. MATERIALS AND METHODS: From 2019 to 2020, 70 children with defects of distal phalanges were treated. The coverage of defects was performed by using a flap (n = 23), cross-finger flap (n = 5), V-Y advancement flap (n = 28), reverse-flow homodigital island flap (n = 11), and full-thickness skin graft (n = 3). Results of the defect coverage were evaluated by objective (difference between the lengths of the operated and contralateral phalanges, two-point discrimination test, presence/absence of stiffness in the distal interphalangeal joint) and subjective (definition of cold intolerance, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire) criteria. RESULTS: The largest difference between the lengths of the operated and contralateral phalanges was obtained in V-Y plasty. The two-point discrimination sensitivity was the highest in V-Y plasty and a little less with island flap. Cold intolerance was the most common complication of homodigital island flap. Results of the DASH survey was the best in the homodigital island flap and full-thickness skin graft. CONCLUSION: Based on the analysis of the experience of surgeries to close soft tissue defects of the nail phalanges, the best results were obtained with reverse-flow homodigital island, which is considered as the most versatile and reliable approach.

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