scholarly journals Glans reconstruction with the use of an inverted urethral flap after distal penile amputation for carcinoma

2013 ◽  
Vol 85 (1) ◽  
pp. 24 ◽  
Author(s):  
Salvatore Sansalone ◽  
Giulio Garaffa ◽  
Giuseppe Vespasiani ◽  
Alessandro Zucchi ◽  
Franklin Emmanuel Kuehhas ◽  
...  
Keyword(s):  
Oral Mucosa ◽  
Reconstructive Surgery ◽  
Functional Outcomes ◽  
Donor Site ◽  
Functional Results ◽  
Donor Site Morbidity ◽  
Skin Grafts ◽  
Urinary Function ◽  
Thickness Skin

Restoration of adequate cosmesis and preservation of sexual and urinary function are the main goals of penile reconstructive surgery following amputation for carcinoma. Split thickness skin grafts and oral mucosa grafts have been widely used for the creation of a pseudoglans with excellent cosmetic and functional results. The main drawbacks associated with the use of grafts are donor site morbidity, the lack of engorgement of the pseudoglans and the risk of poor graft take, which may lead to contracture and poor cosmetic results. In the present series the long term cosmetic and functional outcomes of glans reconstruction with an inverted distal urethral flap are described.

scholarly journals Bilateral Metacarpal Hands: Reconstruction With 6 Toe Transfers

Hand ◽  
2018 ◽  
Vol 15 (4) ◽  
pp. 465-471
Author(s):  
Neil F. Jones ◽  
David Graham ◽  
Katherine Au
Keyword(s):  
Functional Outcomes ◽  
Donor Site ◽  
Psychological Impact ◽  
Hand Surgery ◽  
Functional Results ◽  
Donor Site Morbidity ◽  
Hand Injuries ◽  
Great Toe ◽  
Hand Transplantation

Background: Bilateral metacarpal hand injuries are extremely rare, but probably represent the most difficult reconstructive challenge in hand surgery. Methods: We discuss the various options for metacarpal hand reconstruction, including the Krukenberg procedure, bionic prostheses, multiple toe-to-hand transfers, and possibly hand transplantation, and present the long-term functional outcomes, gait analysis, and psychological evaluation after a 4-stage reconstruction of bilateral metacarpal hands in a child using 6 toe-to-hand transfers—bilateral great toe transfers to reconstruct both thumbs and bilateral combined second-third monobloc transfers to reconstruct 2 fingers in each hand. Results: Reconstruction of bilateral metacarpal hands with 6 toe transfers yielded excellent functional results and patient satisfaction. Conclusions: Bilateral metacarpal hand injuries result in a devastating functional deficit and a major psychological impact. Multiple toe transfers (4, 5, or 6) provide an excellent reconstructive outcome with acceptable donor site morbidity.

Reduction in Donor Site Morbidity: Full-Thickness Skin Columns vs Split-Thickness Skin Grafts

2020 ◽  
Vol 231 (4) ◽  
pp. e186-e187
Author(s):  
Laura E. Cooper ◽  
Phillip M. Kemp Bohan ◽  
Tyler R. Everett ◽  
Javier A. Chapa ◽  
Sean E. Christy ◽  
...  
Keyword(s):  
Donor Site ◽  
Donor Site Morbidity ◽  
Skin Grafts ◽  
Full Thickness ◽  
Full Thickness Skin ◽  
Thickness Skin

Facial Defect Reconstruction with Scalp Skin Grafts

2017 ◽  
Vol 33 (04) ◽  
pp. 419-422 ◽  
Author(s):  
Matthew Voorman ◽  
John Frodel ◽  
Chelsea Obourn
Keyword(s):  
Donor Site ◽  
Case Series ◽  
Donor Site Morbidity ◽  
Ear Reconstruction ◽  
Skin Grafts ◽  
Facial Skin ◽  
Skin Defects ◽  
Facial Defect ◽  
Thickness Skin ◽  
Scalp Skin

AbstractThe objective of this study is to demonstrate the benefits of scalp-based split-thickness skin grafts as a reconstructive modality for facial skin defects, noting advantages relative to traditional harvest sites. The study is presented as a case series with chart review set in a tertiary referral center. We reviewed the charts of patients with facial skin defects whose reconstruction required more skin than could be harvested with standard full-thickness skin grafting techniques and, accordingly, included a split-thickness skin graft from the adjacent scalp. Preoperative and postoperative photographs, along with operative and postoperative records, were used to evaluate final cosmetic results and complications. We reviewed 15 patients, with ages ranging from 6 to 90 years. Common indications were skin cancer resection, avulsive skin trauma, and ear reconstruction. While patients generally had good cosmetic outcomes, with excellent color matching relative to traditional distant donor sites, a major advantage of the scalp donor site was low donor-site morbidity. Scalp donor sites were commonly reepithelialized at 7 to 10 days postoperatively and had low reported pain scores. There were no major complications. Reconstruction of facial skin defects that require skin coverage with split-thickness skin grafts can optimally be harvested from adjacent scalp skin, providing adequate cosmesis but, perhaps most importantly, much lower donor-site morbidity than with traditional nonhair-bearing donor sites.

scholarly journals The Use of Split-Thickness Skin Grafts on Diabetic Foot Ulcerations: A Literature Review

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Brant McCartan ◽  
Thanh Dinh
Keyword(s):  
Literature Review ◽  
Diabetic Foot ◽  
Primary Closure ◽  
Wound Care ◽  
Donor Site ◽  
Skin Grafting ◽  
Donor Site Morbidity ◽  
Skin Grafts ◽  
Therapeutic Modalities ◽  
Thickness Skin

Diabetic foot ulcerations are historically difficult to treat despite advanced therapeutic modalities. There are numerous modalities described in the literature ranging from noninvasive topical wound care to more invasive surgical procedures such as primary closure, skin flaps, and skin grafting. While skin grafting provides faster time to closure with a single treatment compared to traditional topical wound treatments, the potential risks of donor site morbidity and poor wound healing unique to the diabetic state have been cited as a contraindication to its widespread use. In order to garner clarity on this issue, a literature review was undertaken on the use of split-thickness skin grafts on diabetic foot ulcers. Search of electronic databases yielded four studies that reported split-thickness skin grafts as definitive means of closure. In addition, several other studies employed split-thickness skin grafts as an adjunct to a treatment that was only partially successful or used to fill in the donor site of another plastic surgery technique. When used as the primary closure on optimized diabetic foot ulcerations, split-thickness skin grafts are 78% successful at closing 90% of the wound by eight weeks.

scholarly journals Reconstruction of full thickness wounds using glyaderm in a single-staged procedure

2021 ◽  
Author(s):  
Melissa de Henau ◽  
Anne Sophie Kruit ◽  
Dietmar J. O. Ulrich
Keyword(s):  
Donor Site ◽  
Case Series ◽  
Skin Surface ◽  
Donor Site Morbidity ◽  
Dermal Substitute ◽  
Skin Grafts ◽  
Full Thickness ◽  
Graft Take ◽  
Aesthetic Appearance ◽  
Thickness Skin

Abstract Introduction In large full-thickness skin defects, donor site morbidity limits the available thickness and surface of skin autografts and therefore only split-thickness skin grafts are possible for reconstruction. Dermal equivalents can be added to these split-thickness grafts to acquire an anatomically better skin reconstruction. Glyaderm is a human derived, acellular dermis and up until now has only been used in a two-staged procedure. This report describes results of a case series using Glyaderm and split-thickness skin grafts in a single-staged procedure. Methods Glyaderm was introduced in 2017 in Radboudumc (Nijmegen, The Netherlands). Glyaderm and autologous split-skin grafts were simultaneously applied to the wounds. In cases with large wound surfaces or wounds covering highly mobile areas, negative pressure wound therapy was additionally applied. The first ten cases were followed with regular intervals post-operatively, assessing graft take, scar appearance, post-operative wound problems and re-interventions. Results Patients were aged 3 weeks to 76 years-old. Treated skin surface varied from 1–16% total body surface. Wounds resulted from trauma (n = 4), burns (n = 4) or soft tissue infections (n = 2). Follow-up varied from 4 months to 1.5 years. No complications occurred after surgery. Average take rate was 98%. Two patients had a later re-intervention to further improve the aesthetic appearance of the scarred area. Conclusion Our first results with the application of Glyaderm in a single-staged procedure provided good healing, graft take and scar appearance. Glyaderm was found a suitable dermal substitute in the treatment of full thickness wounds.

137 Maximal Harvest Density of Full-Thickness Skin Columns in Skin Replacement Therapy

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S91-S92
Author(s):  
Laura E Cooper ◽  
Javier A Chapa ◽  
Sean E Christy ◽  
Rodney K Chan ◽  
Anders H Carlsson
Keyword(s):  
Replacement Therapy ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Hair Follicles ◽  
Skin Grafts ◽  
Full Thickness ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Optimal Harvest ◽  
Skin Replacement

Abstract Introduction Split-thickness skin grafts (STSGs) are the mainstay of skin replacement therapy but fail to adequately reproduce basic skin functions and subject patients to new, open wounds that can cause significant pain and scarring. Full-thickness skin grafts (FTSGs) have improved cosmetic outcomes and better recapitulate skin functions, but few sites can serve as donors and requirement for “take” is greater. Prior research has shown that full-thickness skin column (FTSC) harvest results in improved healing of the injured site and decreased morbidity of the donor site at 10% harvest density. This study aims to determine the maximal harvest density of FTSC donor sites. Methods Ten donor sites were created on the dorsum of anesthetized swine (Sus scrofa domestica). STSG donor sites were harvested with a dermatome (12/1000 inch) and compared to FTSC donor sites with the highest possible harvest ratio of sixteen 1.5mm-diameter skin columns/1cm2 (28% harvest density). Donor site morbidity was assessed via re-epithelialization, contraction, pigmentation, number of hair follicles, and scar thickness on post-burn day (PBD) 7, 14, 21, 28, 60, and 90. Results There were no significant differences in re-epithelialization or contraction between FTSC and STSG donor sites. STSG donor site pigmentation was significantly decreased as compared to control on all assessment days (p=0.0161, 0.0003, 0.0031, 0.0095, 0.0244, respectively), and remained significantly hypopigmented as compared to FTSC starting at PBD 14 (p< 0.0001). Pigmentation was decreased for FTSC donor sites at PBD 14 (p=0.0204) but significance was lost by PBD 21. Both FTSC and STSG donor sites showed significantly fewer hair follicles as compared to control at PBD 7 (p=0.0011, 0.0003, respectively). On PBD 21, STSG had significantly less hair follicles as compared to FTSC donor sites (p=0.0010). This resolved by PBD 28. FTSC scars were significantly thicker than both control and STSG at PBD 28 (p=0.0348, 0.0038, respectively) and PBD 60 (p=0.0174, 0.0329, respectively). This significance was lost by PBD 90. Conclusions No statistically significant differences were seen in re-epithelialization and contraction between FTSC and STSG donor sites. STSG were hypopigmented as compared to FTSC donor sites and had significantly less hair follicles at day 21. FTSC donor site scars were significantly thicker than STSG. Although decreased donor site morbidity has been observed at lower harvest densities (10%), these results were not seen at 28%, which likely exceeds the optimal harvest density.

Donor site morbidity of postauricular free flaps and full thickness skin grafts

2021 ◽  
Author(s):  
Chihena H. Banda ◽  
Mitsunaga Narushima ◽  
Kohei Mitsui ◽  
Kanako Danno ◽  
Minami Fujita ◽  
...  
Keyword(s):  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Skin Grafts ◽  
Full Thickness ◽  
Full Thickness Skin ◽  
Thickness Skin

Thin and Ultra-Thin Split-Thickness Skin Grafts Are Safe and Efficacious in the Burn Population

2019 ◽  
Vol 41 (4) ◽  
pp. 849-852
Author(s):  
Miranda A Chacon ◽  
Jacqueline Haas ◽  
Trevor C Hansen ◽  
Oren P Mushin ◽  
Derek E Bell
Keyword(s):  
Physical Therapy ◽  
Functional Outcomes ◽  
Cohort Analysis ◽  
Donor Site ◽  
Burn Patients ◽  
Skin Grafts ◽  
Inclusion Criteria ◽  
Graft Take ◽  
Thickness Skin ◽  
Surgeon Experience

Abstract Split-thickness skin-grafts are a mainstay of burn management. Studies suggest no benefit to using thick (0.025 inch) over standard (0.012–0.020 inch) grafts, and some support the use of thin (0.008 inch) over standard thickness. Data on the use of even thinner grafts is scarce. This study reviewed outcomes of burn patients treated with thin (0.008–0.011 inch) and ultra-thin (≤0.007 inch) grafts. Retrospective review of records from July 2012 to June 2016 included patients who sustained operative burns treated by a single surgeon. Patients were excluded for nonoperative injuries, inhalational injuries, or prolonged hospitalizations. Outcome measures were compared between thin and ultra-thin groups. One-hundred twenty-eight patients met inclusion criteria; 35 received thin split-thickness skin-grafts while 93 received ultra-thin. Cohort analysis demonstrated equivalent graft-take, time to reepithelialization, and functional outcomes. Time to donor-site healing was significantly faster in the ultra-thin cohort (P = .04). Of those with functional outcomes recorded, 88.1% had good-excellent function and 11.9% retained a limitation in function as designated in physical therapy notes. There were fewer complications overall (P = .004) and a lower incidence of hypertrophic scarring (P = .025) in the ultra-thin cohort. This study presents a single-surgeon experience with thin and ultra-thin split-thickness skin-grafts. These grafts are exhibit excellent graft-take and few complications. There was no correlation between thickness and functional outcome at the time of physical therapy discharge. Donor-site reepithelialization was faster with ultra-thin grafts, which may be important in patients with large burns and limited donor sites.

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