scholarly journals Management of ulcers in lymphoedematous limbs

2012 ◽  
Vol 45 (02) ◽  
pp. 261-265 ◽  
Author(s):  
Vishnu M. Karnasula
Keyword(s):  
Surgical Intervention ◽  
Psychological Impact ◽  
Skin Grafting ◽  
Psychological Problem ◽  
Shape Distortion ◽  
Skin Changes ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

ABSTRACTLymphoedema is a progressive condition that can have a marked physical and psychological impact on affected patients and significantly reduce the quality of life. The ulcers on chronic lymphoedema patient, which often also makes it impossible for them to work. If left untreated, tends to progress or worsen. Ulcers in lymphoedema patients, therefore, represent not only a medical but also a psychological problem. The treatment is often regarded as being worse than it actually is. In our study of more than 25 years shows around 10% cases are due to chronic lymphodema. Ulcers of chronic lymphoedema are classified into four stages according to their presentation. Their management depends upon their stage of presentation. Patients with chronic lymphoedema and ulceration require a different approach to treatment. The specific issues associated with managing the patient with lymphoedematous ulceration include, limb shape distortion i.e., elephantiasis, care of the skin creases and folds, and swelling of the toes and fore foot. Stage I ulcers will heal with conservative treatment without any surgical intervention. Stage II ulcers needs debridement of the wound and split-thickness skin grafting. The most difficult to treat are the stage III and IV ulcers, due to associated skin changes and reduced vascularity. These cases need debulking along with excision of the ulcer. In order to prevent recurrence of the ulcer in all the four stages needs prolonged follow-up and limb care.

Utility of Porcine-Derived Xenograft as an Adjunct to Split-Thickness Skin Grafting in Lower-Extremity Wounds

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Jenna C. Bekeny ◽  
Christopher Kennedy ◽  
Jon D. Turissini ◽  
Iram Naz ◽  
Elliot T. Walters ◽  
...  
Keyword(s):  
Wound Healing ◽  
Lower Extremity ◽  
Hemoglobin A1c ◽  
Skin Grafting ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Patient Reported ◽  
Wound Bed Preparation ◽  
Future Work

Objective Porcine-derived xenograft biological dressings (PXBDs) are occasionally used to prepare chronic wound beds for definitive closure before split-thickness skin grafts (STSGs). We sought to determine whether PXBD influences rate of STSG take in lower-extremity wounds. Methods Lower-extremity wounds treated with STSGs were retrospectively reviewed. Patients were included in one of two groups: wound bed preparation with PXBD before STSG or no preparation. Patients were excluded if they received wound bed preparation via another method. Patient demographics, comorbidities, wound history, wound bed preparation, and 30- and 60-day outcomes were collected. Results There was no difference in healing outcomes between the PXBD (n = 27) and no preparation (n = 39) groups. At 30- and 60-day follow-up, percentage of STSG take was not significantly different between groups (77.9% versus 79.0%, P30 = .818; 82.2% versus 80.9%, P60 = .422). Mean wound sizes at these follow-up periods were not different (4.4 cm2 versus 5.1 cm2, P30 = .902; 1.2 cm2 versus 1.1 cm2, P60 = .689). The PXBD group had a higher mean ± SD hemoglobin A1c level (8.3 ± 3.5 versus 6.9 ± 1.6; P = .074) and age (64.9 ± 12.8 years versus 56.3 ± 11.9 years; P = .007) versus the no preparation group. Conclusions Application of PXBDs for wound bed preparation had no effect on wound healing compared with no wound bed preparation. The two groups varied only by mean age and hemoglobin A1c level. The PXBD may be beneficial, but these results call for randomized controlled trials to determine the true impact of PXBDs on wound healing. In addition, PXBDs may have utility outside of clinically oriented outcomes, and future work should address patient-reported outcomes and pain scores with this adjunct.

Management of severe hand wounds with integra® dermal regeneration template

2010 ◽  
Vol 36 (3) ◽  
pp. 185-193 ◽  
Author(s):  
R. Weigert ◽  
H. Choughri ◽  
V. Casoli
Keyword(s):  
Clinical Experience ◽  
Free Flap ◽  
Skin Grafting ◽  
Effective Technique ◽  
Flap Coverage ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Dermal Regeneration Template ◽  
Dermal Regeneration

We report our experience with the use of Integra® for the management of severe traumatic wounds of the hand. Fifteen patients were treated with follow-up ranging from 10 to 37 months. Wounds were associated with an osseous and/or joint and/or tendon exposure. Following Integra® placement, patients were managed with dressings and subsequent split-thickness skin grafting an average of 26 days later. Integra® was successful in achieving durable, functional and aesthetic definitive coverage in 13 of 15 applications while allowing a satisfying pollicidigital prehension. Regarding our clinical experience, Integra® is an effective technique to deal with severe wounds of the hand with exposed tendon and/or bone and/or joint, even in the absence of paratenon or periosteum. This can potentially lessen the need for local rotational or free flap coverage and should be taken into consideration as a viable alternative in traumatic reconstruction of the hand.

scholarly journals Safety of Early Postoperative Range of Motion in Burn Patients With Newly Placed Hand Autografts: A Pilot Study

2020 ◽  
Vol 41 (4) ◽  
pp. 809-813
Author(s):  
William Scott Dewey ◽  
Kyle B Cunningham ◽  
Sarah K Shingleton ◽  
Kaitlin A Pruskowski ◽  
Ashley Welsh ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Graft Loss ◽  
Skin Grafting ◽  
Thickness Skin ◽  
Additional Surgery ◽  
Split Thickness Skin Grafting ◽  
Risk Areas ◽  
Matched Case ◽  
Hand Burns

Abstract Patients who suffer hand burns are at a high contracture risk, partly due to numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting are often immobilized postoperatively for graft protection. Recent practice at our burn center includes an early range of motion (EROM) following hand grafting to limit unnecessary immobilization. The purpose of this study was to determine whether EROM is safe to perform after hand grafting and if there is any clinical benefit. This retrospective, matched case–control study of adults compared patients who received EROM to subjects who received the standard 3 to 5 days of postoperative immobilization. Patients were evaluated for graft loss and range of motion. Seventy-one patients were included in this study: 37 EROM patients and 34 matched controls. Six patients experienced minor graft loss, three of these were not attributable to EROM. All graft loss was less than 1 cm and none required additional surgery. Significantly more patients who received EROM achieved full-digital flexion by the first outpatient visit (25/27 = 92.6% vs 15/22 = 68.2%; P = .028). Performing EROM does not cause an increase in graft loss. All areas of graft loss from the EROM group healed without intervention. There appears to be a benefit to EROM since there was a significant improvement in the patients’ ability to make a full fist at initial outpatient follow-up. Additional prospective analysis is needed to examine the true clinical utility of EROM in the hand and other contracture-prone areas.

T2 Safety of Early Post-operative Range of Motion in Burn Patients with Newly Placed Hand Autografts

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S1-S2 ◽  
Author(s):  
William S Dewey ◽  
Kyle B Cunningham ◽  
Sarah K Shingleton ◽  
Kaitlin A Pruskowski ◽  
Ashley M Welsh ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Graft Loss ◽  
Skin Grafting ◽  
Operative Management ◽  
Adult Patients ◽  
Thickness Skin ◽  
Additional Surgery ◽  
Split Thickness Skin Grafting ◽  
Hand Burns

Abstract Introduction Patients who suffer hand burns are at a high risk for developing contractures, partly due to the presence of numerous cutaneous functional units, or contracture risk areas, located within the hand. Patients who undergo split-thickness skin grafting (STSG) are often immobilized post-operatively for graft protection. Restricting mobility following a STSG is thought to protect against subdermal edema and shear forces, despite limited evidence. Early range of motion (EROM) has been described previously. Recent practice at our burn center includes EROM following hand STSG to limit unnecessary immobilization. The purpose of this retrospective study was to determine if EROM is safe to perform after hand STSG and if there is any clinical benefit. Methods In an approved, retrospective, matched case-control study of adult patients who sustained hand burns, patients who received EROM were defined as cases; patients who did not receive EROM were considered controls and received the standard 3–5 days of post-operative immobilization in a resting hand splint. Adult patients admitted over a 3-year period were eligible for inclusion. Patients were evaluated for graft loss and range of motion. Results Seventy-two patients were included in this study; 37 EROM patients and 35 matched controls. EROM patients tended to have a larger area excised (170.4 ± 69.8cm2 vs. 132.9 ± 76.2cm2; p=0.034) and grafted (171 ± 70.8 cm2 vs. 132.9 ± 76.2 cm2; p=0.033). Most patients were male, with an average age of 39 years. Patients had an average of approximately 5% TBSA burns with 1.5% to the hands. On post-op day (POD) 1 and 2, patients received EROM for an average of 30 minutes (29.25 ± 14.9 vs. 31 ± 16.4 minutes). Six patients experienced minor graft loss. Three patients (8%) experienced graft loss not attributable to EROM. One patient (2.7%) experienced graft loss pre-EROM on POD2 and 3 patients (8%) experienced graft loss post-EROM on either POD1 or POD2. All graft loss was less than 1 cm in greatest dimension and no patient who experienced graft loss required additional surgery as they all closed by their first outpatient follow-up. Significantly more patients who received EROM achieved full digital flexion by the first outpatient visit (25/27=92.6% vs. 15/22=68.2%; p=0.028). Conclusions Performing EROM does not cause an increase in graft loss. All areas of graft loss from the EROM group healed without intervention. There appears to be a benefit to EROM since there was a significant improvement in the patients’ ability to make a full fist at initial outpatient follow up. Further prospective analysis is needed to examine the true clinical utility of EROM in the hand and other contracture-prone areas. Applicability of Research to Practice Clinical change in post-operative management after hand grafting.

scholarly journals Vacuum-assisted closure dressing in split-thickness skin grafting

2019 ◽  
Vol 10 (3) ◽  
pp. 1735-1740
Author(s):  
Ali A Ali ◽  
Yasir N Qassim ◽  
Ali N Areef
Keyword(s):  
Skin Graft ◽  
Chronic Wounds ◽  
Skin Grafting ◽  
Split Thickness Skin Graft ◽  
Vacuum Assisted Closure ◽  
Wound Site ◽  
Graft Take ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Vacuum-assisted closure (VAC) has been applied to a variety of acute and chronic wounds that are difficult to manage, and is associated with improved wound healing outcomes. It involves the application of sub-atmospheric pressure in a controlled way to secure a split-thickness skin graft on the wound that has been sealed with an occlusive dressing.A study was conducted on the patients with a variety of indications for skin grafting, admitted to Azadi Teaching Hospital between March 2010 and August 2017. After the application of split-thickness skin graft, a closed, controlled suction was applied on the wound. The graft was then continuously observed, and the dressing was changed as needed.A total of 39 split-thickness skin grafting procedures were performed on 37 patients (20 male, 17 female), the age of the patients ranging between 7 and 68 years. The average grafted area was 12±70 cm2, and the percent graft take ranged from 90 - 100%.Vacuum-assisted closure opposes the graft firmly on the wound bed, sucks out the seroma and/or hematoma, prevents shearing of the graft and aids in immobilization of the grafted part; thus improving the quantity and quality of the graft take. This study also established that VAC was particularly useful when the wound site is difficult to access, the wound is highly contoured and the conditions are less-than-ideal for complete graft take.

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

2019 ◽  
Vol 7 ◽  
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.

Outcomes of Split Thickness Skin Grafting on Lower Extremity Wounds in Diabetics

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 111-OR
Author(s):  
ELLIOT WALTERS ◽  
GREG STIMAC ◽  
NEHA RAJPAL ◽  
IRAM NAZ ◽  
TAMMER ELMARSAFI ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Skin Grafting ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

Effectiveness of the Chiari Health Index for Pediatrics instrument in measuring postoperative health-related quality of life in pediatric patients with Chiari malformation type I

2020 ◽  
pp. 1-6
Author(s):  
Georgina E. Sellyn ◽  
Alan R. Tang ◽  
Shilin Zhao ◽  
Madeleine Sherburn ◽  
Rachel Pellegrino ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Type I ◽  
Health Related Quality ◽  
Health Index ◽  
Chiari Malformation Type I ◽  
Related Quality ◽  
Health Related ◽  
Over Time

OBJECTIVEThe authors’ previously published work validated the Chiari Health Index for Pediatrics (CHIP), a new instrument for measuring health-related quality of life (HRQOL) for pediatric Chiari malformation type I (CM-I) patients. In this study, the authors further evaluated the CHIP to assess HRQOL changes over time and correlate changes in HRQOL to changes in symptomatology and radiological factors in CM-I patients who undergo surgical intervention. Strong HRQOL evaluation instruments are currently lacking for pediatric CM-I patients, creating the need for a standardized HRQOL instrument for this patient population. This study serves as the first analysis of the CHIP instrument’s effectiveness in measuring short-term HRQOL changes in pediatric CM-I patients and can be a useful tool in future CM-I HRQOL studies.METHODSThe authors evaluated prospectively collected CHIP scores and clinical factors of surgical intervention in patients younger than 18 years. To be included, patients completed a baseline CHIP captured during the preoperative visit, and at least 1 follow-up CHIP administered postoperatively. CHIP has 2 domains (physical and psychosocial) comprising 4 components, the 3 physical components of pain frequency, pain severity, and nonpain symptoms, and a single psychosocial component. Each CHIP category is scored on a scale, with 0 indicating absent and 1 indicating present, with higher scores indicating better HRQOL. Wilcoxon paired tests, Spearman correlations, and linear regression models were used to evaluate and correlate HRQOL, symptomatology, and radiographic factors.RESULTSSixty-three patients made up the analysis cohort (92% Caucasian, 52% female, mean age 11.8 years, average follow-up time 15.4 months). Dural augmentation was performed in 92% of patients. Of the 63 patients, 48 reported preoperative symptoms and 42 had a preoperative syrinx. From baseline, overall CHIP scores significantly improved over time (from 0.71 to 0.78, p < 0.001). Significant improvement in CHIP scores was seen in patients presenting at baseline with neck/back pain (p = 0.015) and headaches (p < 0.001) and in patients with extremity numbness trending at p = 0.064. Patients with syringomyelia were found to have improvement in CHIP scores over time (0.75 to 0.82, p < 0.001), as well as significant improvement in all 4 components. Additionally, improved CHIP scores were found to be significantly associated with age in patients with cervical (p = 0.009) or thoracic (p = 0.011) syrinxes.CONCLUSIONSThe study data show that the CHIP is an effective instrument for measuring HRQOL over time. Additionally, the CHIP was found to be significantly correlated to changes in symptomatology, a finding indicating that this instrument is a clinically valuable tool for the management of CM-I.

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