A comparative study of graft uptake in split skin grafting between the first postoperative dressing done on day 3 versus day 5

Background: Skin grafting offers a method of regaining skin continuity. The common causes of skin graft failure are hematoma, seroma, infection. These affect the graft uptake maximally in the initial postoperative period by impairing graft adherence and subsequent revascularization. Aim of study was to compare graft uptake, rejection, seroma and infection among first postoperative dressing on day 3 versus day 5.Methods: A comparative, prospective study conducted at our institute from November 2015 to April 2021, with 100 patients who underwent SSG (split skin grafting) who were distributed into two groups. Group A underwent the first postoperative dressing on day 3 and group B on day 5. The second postoperative dressing was done 2 days following the first. The grafted site was then assessed on for the percentage of graft uptake, rejection, seroma, infection clinically and through culture and sensitivity.Results: The mean graft uptake in group A was 88.48% whereas in group B was 82.62% in the first dressing and in the second dressing, group A was 88.14% whereas group B was 78.02%, with statistically significant data and thus showing less rejection and infection rate in group A. Seroma was present in 82% of cases in group A and 74% in group B on 1st postoperative dressing which reduced to 6% and 12% respectively with the 2nd dressing.Conclusions: Thus, the first postoperative dressing done on Day 3 following skin grafting, significantly increased the final uptake of the graft, reduced seroma, infection and rejection rate.

Rare giant dermatofibrosarcoma protuberans with uncommon fibrosarcomatous transformation - case report and review of literature

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma with aggressive local behavior but with a low metastatic potential. Although slow growing and indolent, they rarely reach huge sizes. Very uncommonly, these locally invasive tumors undergo fibrosarcomatous transformation with a more aggressive clinical course, with higher rate of recurrence risk and distant metastases. A 32-years-old lady, presented with a gradually progressive lump in the upper central back for the past 6 years, with rapid progression in size during the last 6 months. On examination, she had a single lump of size 18×18 cm in the midline of the upper back, with prominent veins over its surface. Magnetic resonance imaging (MRI) showed no connection with the spinal canal and appeared flush with the paraspinal muscles. Core needle biopsy showed DFSP. The patient underwent a wide local excision with split skin grafting. The histopathology now showed a fibrosarcomatous transformation of DFSP. The patient again underwent a wide re-excision with a 3 cm margin. Histology reported no evidence of tumor cells in the specimen. The patient’s postoperative period was uneventful and she was referred for adjuvant radiotherapy. DFSP is a rare, slow-growing malignant fibroblastic mesenchymal skin tumor with low metastatic potential. However, in any patient with long standing DFSP with a recent increase in size, this fibrosarcomatous transformation must be kept in mind as it represents an uncommon form of DFSP that tends to follow a more aggressive clinical course, with higher rate of recurrence risk and distant metastases.

1001 Atraumatic Bilateral Compartment Syndrome; A Case Report

Introduction We present a rare case of lower leg atraumatic bilateral compartment syndrome (ABCS). To date there have only been three similar cases reported where no cause was identified. Case Study A 33-year-old male presented 12 hours following sudden onset lower leg pain. There was no history of trauma, drug, or alcohol use. On assessment he was in significant pain, not relieved by analgesia, and had clinically tense anterior compartments bilaterally. Both feet were held in fixed dorsiflexion. Creatinine kinase (CK) was 35,166 on admission. X-rays of both legs were normal. He was immediately taken to theatre for bilateral four compartment fasciotomies which revealed significant swelling in the anterior and lateral compartments with patchy pre-necrosis. Post-operatively he deteriorated, required intubation, and was admitted to ITU for acute haemofiltration to treat acute kidney injury secondary to rhabdomyolysis. Multiple operations were required for debridement, resulting in exposed tendons. Closure of the medial wounds was achieved primarily as an inpatient and he was discharged with bilateral lateral VAC dressings in situ. Lateral wounds were closed with Biodegradable Temporising Matrix followed by split skin grafting. In his second admission he suffered a pulmonary embolism. Literature Review and Discussion 20 case of ABCS have been reported, largely attributable to drugs, alcohol, or leg position. Most cases had an element of diagnostic delay. In addition to compartment pressure monitoring, testing CK can demonstrate muscle necrosis and supports the decision to proceed to surgery.

Successful surgical management of primary abdominal wall mucormycosis in an immunocompetent patient

Primary abdominal wall mucormycosis rarely occur in immunocompetent, non-diabetic patients but may affectin patients with traumatic injury with contaminated wounds and patients underlying malignancies usually infiltrating into skin. Herein we are reporting a case of primary cutaneous mucormycosis in a 17-year-old male without immunodeficiency or any comorbidity. He was managed with multiple debridement of the wound and intravenous amphotericin B therapy with cumulative dose of 2000 mg of liposomal amphotericin B followed by split skin grafting. We would like to emphasize the importance of high index of suspicionof fungal sepsis and early start of antifungal therapy in this condition can reduce high rate of mortality and management of large wound with split skin grafting in same setting to avoid morbidity.

Minimalistic reconstruction of exposed skull in a complex craniovertebral polytrauma

Background: In stable craniovertebral injuries complicated by polytrauma, rigorous spinal immobilization is essential for neuroprotection. Scalp and forehead reconstruction in these circumstances are safest when performed under local anesthesia, maintaining cervical immobilization. Case Description: A sizeable 10 × 6.5 cm forehead defect was reconstructed utilizing regenerative principles under local anesthesia and sedation in a 54-year-old woman. After adequate debridement of gangrenous soft tissues, exposed outer skull bones were trephined, forehead defect covered with a synthetic biomaterial, and the patient was discharged thereafter. Granulating neodermis regenerated within the biomaterial over the next 6 weeks. Weekly platelet-rich plasma injections along the wound margins facilitated wound regeneration. Dimensions reduced by two-thirds to 6.5 × 3.5 cm with wound regeneration and contraction, while granulating neodermis covered the remaining skull-bones. Split skin-grafting over the neodermis ensured satisfying long-term results, with similar color, texture, soft-tissue thickness, and sensation. Multiple occipitocervical, spinal, scapular, and rib fractures healed well with strict immobilization. Conclusion: Good long-term results were achieved with significantly reduced dangers, complications, hospitalization, and costs than traditional reconstructive flap surgeries. Minimalistic reconstruction utilizing tissue engineering and regenerative medicine principles appears beneficial for patients with grave spinal injuries.

A retrospective study of comparison of collagen dressing versus conventional dressing for skin graft donor site

Background: Split-skin grafting is commonly employed for covering skin defects in case of ulcers, deep burns and following trauma. It involves harvesting of the epidermis and upper 1/3rd of dermis resulting in a wound called donor site wound (DSW). These wounds pose a kind of burden to patients during the process and after the process of wound healing. These wounds tend to cause pain, are at risk of getting infected, pruritis and cosmetic inconvenience. DSW has been managed with closed or open dressings. Out of many methods, we aim to compare the efficacy of collagen dressing with that of conventional dressing in this study.Methods: A retrospective study including 30 subjects were stratified into 2 groups; group A-collagen dressing and group B- conventional dressing. Patients aged between 18 to 60 years undergoing split thickness skin grafting were included. Patients who are immunocompromised, diabetic, with underlying skin disease and infected wounds were excluded. The outcome was compared in terms of pain, pruritis and scar assessment using Vancouver scar scale.Results: In the present study there was significant difference in median pain score, pruritus and median Vancouver scar score in collagen group compared to conventional group at all the intervals. Also, the incidence of surgical site infection was lower in the collagen dressing group.Conclusions: Collagen dressing is superior compared to conventional dressing in terms of lower pain score, pruritus score and Vancouver scar score.

500 Tetraminos Flap

30 year old male, who had been hit at 90mph whilst on a motorbike sustaining femoral, tibial and right foot open fractures. He underwent an open reduction and internal fixation (ORIF) of his right lateral femoral condyle, a right retrograde femoral nail, and ORIF of the tibia. He had 2 separate free flaps (a chimera scapular/parascapular and antero-lateral thigh-ALT) to his right lower leg, and split skin grafting to the remainder of the right lower limb. Upon regular post-operative review it was found that whilst healed the limb was showing a poor return of function and a major contributor was the lack of motion of the right knee joint. Patient had an excision of the split skin graft, with a quadriceps plasty, where the myofascial planes were released, and the contractures incised, with a chimeric scapular and parascapular free flap onto the defect. This resulted in coverage of large soft tissue defect with no need to skin graft donor sites and no functional implication of muscle harvest. Tetraminos in appearance, like the popular computer game, which has never before been described, compared with normal coverage, which would be latissimus dorsi free flap and graft.