Autologous full-thickness skin graft as reinforcement in parastomal hernia repair: a randomised controlled trial

Background Parastomal hernia is a common complication of an enterostomy and can have a significant impact on health-related quality of life. Currently used methods of repair have high recurrence rates and considerable risk for complications. We have developed a new technique for parastomal hernia repair that uses full-thickness skin graft as reinforcement. Methods This study protocol describes a multicentre randomised controlled trial on parastomal hernia repair comparing a new full-thickness skin graft technique with conventional synthetic composite mesh as reinforcement of the abdominal wall. Patients with a symptomatic parastomal hernia will be included and followed up at 3, 12 and 36 months, with surgical complication as the primary outcome. Secondary outcomes will be recurrence rate and health-related quality of life assessed with VHPQ, EORTC C30 and CR29. Tissue biology and collagen metabolism will be investigated pre- and postoperatively using biopsies of the abdominal wall fascia and blood samples. Discussion Parastomal hernia constitutes a major clinical problem where the prospects of a good result after hernia repair are presently poor. This new method of repair with full-thickness skin grafting could be a new alternative in our surgical toolbox, but before then, it must be evaluated properly. Trial registration ClinicalTrials.gov NCT03667287. Registered on September 12, 2018

AUTOLOGOUS FULL THICKNESS SKIN GRAFT WOUND HEALING ON SPRAGUE DAWLEY RATS Reviewed From TGF-? Expression And Neutrophil Number

Introduction : Skin grafts are now one of treatment option in wound healing process that is always developing. TGF-bexpression and the number of neutrophils have an important role in healing skin graft wounds. Ozone (O3) has disinfecting properties that are effective in wound healing. Objective : Proving the effectiveness of Ozonated VCO for Full Thickness Skin Graft wound healing using parameter of TGF-b expression and neutrophil number. Method : This study is an experimental study with a post-test only design group of 40 Sprague Dawley rats performed autologous skin graft at the same time. Samples were divided randomly into 8 groups (K1 = without Ozonated VCO), (A1 = Ozonated VCO 50 mg / ml), (B1 = Ozonated VCO 100 mg / ml), (C1 = Ozonated VCO 200 mg / ml), ( K2 = without Ozonated VCO) (A2 = Ozonated VCO 50 mg / ml), (B2 = Ozonated VCO 100 mg / ml), (C2 = Ozonated VCO 200 mg / ml). Assessment of TGF-b expression and neutrophil number of tissue was performed by staining hematoxylin & eosin and immunohistochemistry on days 6 and 12 after skin graft. Results : There were significant differences (p <0.05) TGF-b expression and neutrophils number of tissue between the control group and the administration of Ozonated VCO doses of 50 mg / ml, 100 mg / ml and 200 mg / ml on days 6 and 12 post skin graft. Conclusion : The administration of Ozonated VCO effectively improve Full Thickness Skin Graft wound healing seen from macroscopic wounds, increase TGF-b expression and decrease the number of neutrophils.

Effects of Caffeine Consumption on Autologous Full-Thickness Skin Graft Healing in an Animal Model

Background There exists contradictory evidence that states both the beneficial and deleterious effects of caffeine on wound healing. The general population might unknowingly consume caffeine that negatively affects wound healing. The main objective of this study is to investigate the effect of daily caffeine consumption on wound healing, specifically full-thickness skin graft (FTSG). Methods Forty Sprague-Dawley rats were randomized into four groups of equal size: control-dose (CD), low-dose (LD), medium-dose (MD), and high-dose (HD) caffeine groups. After autologous FTSG, all subjects in the intervention group were given daily pure caffeine gavage. The FTSG was explanted 7 days posttransplant. The graft viability, secondary contraction, and adherence were evaluated macroscopically, while fibroblast and collagen deposition was analyzed microscopically with hematoxylin eosin stain. Results The least graft viability (72.8 ± 20.7%, clinical wound assessment scale [CWAS] 2.4), highest secondary contraction (11.4 ± 10.5%), and fibroblast count (331.8 ± 88.6 cells/5 high power fields) were observed in the MD group. More collagen synthesis was observed in subjects who consumed caffeine. The level of secondary contraction, fibroblast count as well as graft viability and collagen synthesis were positively correlated. Conclusions Daily consumption of caffeine impairs graft viability when given in medium dose and increases collagen synthesis, irrespective of dosage. This study was in experimental rats; the results are not directly translatable to humans.

Full-Thickness Skin Graft according to Surrounding Relaxed Skin Tension Line Improves Scar Quality in Facial Defect Coverage: A Retrospective Comparative Study

A full-thickness skin graft (FTSG) is useful for covering small skin and soft tissue defects. In this paper, we suggest FTSG in consideration of the relaxed skin tension line (RSTL) concept for scar quality improvement since FTSG has disadvantages, including contour irregularities and mismatches of color and texture. We conducted a retrospective chart review of twenty-one patients with skin cancer on the face who underwent wide excision and FTSG by a single surgeon from October 2013 to July 2019. Twenty-one patients with skin cancer on the face were divided into RSTL-matched and RSTL-unmatched groups, and FTSG was performed. Each group was subjected to scar assessment three months after surgery. Observer assessment was performed by five independent observers using the observer component of the patient and observer scar assessment scale (POSAS) and Vancouver scar scale (VSS). Our results indicate that there were significant differences between the RSTL-matched and RSTL-unmatched groups in the VSS and POSAS components. In addition, the RSTL-matched group showed a natural appearance with surrounding tissue in the dynamic animation phase compared to the unmatched group. RSTL-matched FTSG can be an attractive option for face skin and soft tissue defect coverage. (An earlier version of this paper has been presented at the International Conference on PRS Korea 2020.)

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 Effectivity of Ozonated VCO on Healing Full Grafted Skin graft Study on Progenitor Cell Endothelial Proliferation and Angiogenesis in Sprague Dawley Mice

Background : Full thickness Skin graft is one technique to accelerate wound healing. EPC proliferation and new blood vessel formation have an important role in the success of Ful thickness Skin graft. Ozone content in Ozonated VCO has the ability to increase growth factors so that it can accelerate wound healing Aims : This study was aimed to prove the effects of ozonated vco in various doses in increasing EPC proliferation and angiogenesis in full thickness skin graft wounds. Methods : This research is an experimental study with randomized post test only with parallel group design. 40 Sprague Dawley rats performed autologous Skin grafts at the same time. Samples were randomly divided into 8 groups, two control groups (X1 and X5), and 6 other groups were given a multi-dose ozonated oil 50.6 mg / ml (X2, X6), 101.3 mg / ml (X3, X7) , 202.6 mg / ml (X4, X8). Conduct termination on day 6 and day 12. Examination of the number of EPC proliferation and the number of angiogenesis in each group. Data were analyzed by Saphiro Wijk, ANOVA, post hoc benferonni and pearsons Results : The number of EPC proliferation in groups X1, X2, X3, X4, X5, X6, X7, X8 has a mean of 6.2 + 0.837, 10 + 1.581, 13.80 + 2.049, 14.80+ 2,280, 9.40 + 2,074 , 13.20 + 1,483, 19,0 + 2,055 and 19.20 + 1,095.The number of Angiogenesis in groups X5, X6, X7, X8 has a mean of 9.20 + 1,095,14,60 + 2,881,17,40+ 3,286, 18,80 + 2,168,17,40 + 3,286,18.80+ 2,168. The administration of ozonated VCO dose of 202.6 mg / ml gave the best results in the amount of angiogenesis (p = 0.001) and the amount of angiogenesis (p=0,001).Correlation analysis between EPC proliferation and angiogenesis showed a significant correlation (p = 0.001 and r = 0.738). Conclusion : Ozonated oil can increase the number of EPC proliferation and angiogenesis in the wound healng process of Full thickness Skin graft. The ozone dose of 202,6 mg / ml showed the best effect on increase wound healing process. Keyword : Full thickness skin graft, Ozonated oil , EPC, Angiogenesis

A complex soft tissue reconstruction of distal phalanges in children

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.