Isolated penile Fournier’s: a caveat

Isolated penile Fournier’s gangrene is a rare condition causing significant morbidity to the patients. It occurs due to urinary tract infection or trauma. We describe an elderly male who presented with blackish discoloration of the skin of the penis with fever. Examination revealed a necrotic patch over the shaft of the penis without any other foci of infection around the perineum. Penis was debrided, and the antibiogram showed Escherichia coli sensitive to amikacin. He received seven days of antibiotics, and the wound granulated well. A split skin graft was used to cover the wound to prevent contraction. This unusual presentation requires expeditious management to prevent mortality and morbidity.

TOTAL PENILE DEGLOVING INJURY RESURFACED WITH A SPLIT SKIN GRAFT – A CASE REPORT

Degloving injuries of the penis are a rare occurrence often requiring reconstruction. They are usually caused by industrial or agricultural machinery and tend to involve both the penile shaft and the scrotal skin with young adults being the usual victims. A penile degloving usually begins just proximal of the coronal line and progress down to the base of the shaft. Deep erectile tissue and the spermatic cord are usually undamaged and the endogenous skin of glans usually survives. The management requires thorough debridement and resurfacing the raw area by either using the degloved skin as a ap or a free skin graft, or by using a split skin or a full thickness skin graft. Here, we report a case of a total penile skin degloving managed with a split skin graft with satisfactory cosmetic result.

The Response and Tolerability of a Novel Cold Atmospheric Plasma Wound Dressing for the Healing of Split Skin Graft Donor Sites: A Controlled Pilot Study

<b><i>Introduction:</i></b> Cold atmospheric plasma (CAP) has positive effects on wound healing and antimicrobial properties. However, an ongoing challenge is the development of specific modes of application for different clinical indications. <b><i>Objectives:</i></b> We investigated in a prospective pilot study the response and tolerability of a newly developed CAP wound dressing for the acute healing of split skin graft donor sites compared to conventional therapy. <b><i>Methods:</i></b> We applied both treatments to each patient (<i>n</i> = 10) for 7 days and measured 4 parameters of wound healing every other day (i.e., 1,440 measurements) using a hyperspectral imaging camera. Additionally, we evaluated the clinical appearance and pain levels reported by the patients. <b><i>Results:</i></b> The CAP wound dressing was superior to the control (<i>p</i> &#x3c; 0.001) in the improvement of 3 wound parameters, that is, deep tissue oxygen saturation, hemoglobin distribution, and tissue water distribution. CAP was well tolerated, and pain levels were lower in CAP-treated wound areas. <b><i>Conclusion:</i></b> CAP wound dressing is a promising new tool for acute wound healing.

Surgical Outcome in Tumescent and Non-Tumescent Method of Harvesting Split Skin Graft - An Observational Study at KR Hospital, Mysuru

BACKGROUND The study was started with the aim to determine take up rate in tumescent technique compared to non-tumescent technique for harvesting split skin graft. Tumescent technique has been practiced for over forty years especially in liposuction. Tumescent anaesthesia is a combination of crystalloid, lignocaine, adrenaline and sodium bicarbonate. Using tumescent local anaesthesia for harvesting a split thickness skin graft is not in much practise. This study was designed to provide strong evidence of this technique. METHODS This was an observational study. Two treatment groups of patients, tumescent (group A, N = 21) and non-tumescent technique (group B, N =21), who fulfilled the inclusion criteria were randomly assigned. Tumescent technique involved administration of Klein’s formula. No prior administration of agent was performed in non-tumescent technique. The recipient site was opened in both groups on the fifth day after surgery and take rate assessed. RESULTS The difference in take up rate between the two groups was found to be statistically significant. Compared to the patients in group B, patients who underwent tumescent technique (group A) had higher take up rate (> 12 %, P = 0.005). We did not find any statistically significant difference in donor site percentage healing between the tumescent and non-tumescent groups, P = 0.379. CONCLUSIONS Tumescent technique gives better take up results and is more effective than nontumescent technique in harvesting split skin graft. The subdermal injection creates a smooth, dense surface which assists donor harvesting. This can be implemented preoperatively in split-thickness skin grafting. KEYWORDS Split Skin Graft, Take Up Rate, Harvesting, Tumescent, Non-Tumescent, Local Anaesthesia

Giant diffuse neurofibroma of the chest wall involving the sternum: challenging chest wall reconstruction

Diffuse neurofibroma is a rare form of neurofibroma, usually reported in the head and neck. To our knowledge, diffuse neurofibroma of the anterior chest wall has not been reported previously. Even rarer is involvement of the sternum in neurofibroma. We report a case of a 30-year-old lady who presented with a rapidly growing, painless giant exophytic mass involving almost the entire anterior chest wall. The tumor mass was infiltrating the sternum. Excision of the tumor left a large full-thickness thoracic defect that was covered using polypropylene mesh beneath a pedicled omental flap with a split skin graft over it.

GLABROUS & NON-GLABROUS SPLIT SKIN GRAFT IN THE RECONSTRUCTION OF FLEXION CONTRACTURE OF FINGERS – AN OBSERVATIONALAND COMPARATIVE STUDY.

Background: Flexion contractures of the fingers cause functional and aesthetic problems to a burn patient. Various methods of reconstruction have been described in the literature. These include release and split thickness grafting, release and full thickness grafting. Among those incision or excision of the contracture band and split skin grafting were the simplest and commonest techniques. In this study, we aim to compare functional & aesthetic outcomes of glabrous & non glabrous split skin graft in flexion contracture of fingers. Methods: A total of 60 fingers of patients of post burn finger contractures were undertaken for the study. Patients were evaluated preoperatively on duration of contracture, extent of involvement, type of scar, range of movements using goniometer and degree of fixed flexion deformity. Finger contractures were released and resurfacing done with glabrous & non-glabrous split thickness skin grafts. Postoperative evaluation was done by measuring range of movements of Proximal Interphalangeal (PIP) and Distal interphalangeal (DIP) joints, flexion deformity, donor site morbidity, number of visits to the hospital, colour match of graft to adjacent skin. Results: Functional outcome in terms of active range of motion combined at DIP joint, PIP joint & metacarpophalangeal joint were similar in both glabrous split thickness skin graft & non glabrous split thickness skin graft at the end of six months. As compared with non-glabrous split thickness skin grafts, glabrous split thickness grafts provided superior colour & texture match to surround tissue. There was no significant donor site morbidity in plantar in-step area & patients were able to walk from third to fourth post operative day. There was minimal hypertrophy of plantar donor site, owing to persistent pressure in standing posture. Conclusion: Patient’s satisfaction was greater in glabrous split skin graft.

Lateral genicular artery flap for reconstruction of defects around the knee: a series of 5 cases

The lateral genicular artery flap is a fasciocutaneous flap used for knee reconstruction with low donor site morbidity. It is raised from the lower lateral thigh and is based upon the cutaneous termination of superior lateral genicular artery. This flap showed constant anatomy and is reliable for coverage of defects at superior and lateral portions of the knee and the proximal part of the lower leg. The study period was from January 2016 to June 2017 where we operated on 5 patients, 3 for post-traumatic and 2 were post burn contracture excision. The flap was used as a pedicled fasciocutanous and was based on the superior lateral genicular artery. Five cases underwent lateral genicular artery flap of which 4 were males and 1 was a female. Mean defect size was 12 cm×10 cm. All the donor sites were closed with a split skin graft. One patient had distal necrosis which was managed conservatively. The lateral genicular artery flap is a thin, versatile, reliable and easy to harvest flap for reconstructing defects around the knee, with good cosmetic and functional outcome.