Single, large, meshed full-thickness free skin graft for reconstruction of a dorsal lumbosacral wound defect in a dog

CASE DESCRIPTION A 12-year-old 32-kg neutered female crossbreed dog was treated for a large lumbosacral skin defect. CLINICAL FINDINGS The dog had sustained multiple, penetrating dog bite wounds to the lumbosacral and gluteal regions 5 days earlier. The referring veterinarian had initiated treatment with amoxicillin–clavulanic acid, which was continued at a dosage of 8.75 mg/kg, SC, every 24 hours at the referral hospital. Examination of the skin defect revealed a large subcutaneous abscess in the dorsal lumbosacral region with draining perimeter tracts at the wound margin. The partial-thickness wound measured 24 × 35 cm and had multifocal regions of necrosis extending caudally from the dorsal aspect of the T11 vertebra to the tail base. The skin defect was bounded by discolored and necrotic skin edges. TREATMENT AND OUTCOME The dog underwent extensive soft tissue wound reconstruction. A single, large, meshed full-thickness free skin graft was harvested from the left dorsolateral aspect of the thorax and grafted to the dorsal lumbosacral region, thereby enabling successful closure of the wound defect. Primary healing of the wound eventually occurred, without postoperative complications. CLINICAL RELEVANCE Use of a large, meshed full-thickness free skin graft led to a satisfactory outcome for this dog but required challenging postoperative management. Application of single, large, meshed full-thickness free skin grafts may be an option to manage large skin deficits in the lumbosacral area in dogs.

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.

Geometrical Model of Free Skin Graft for the Optimization of Glans Reconstruction after Partial Penectomy

Introduction and Objective The management of penile carcinoma is very disabling and mutilating, bur early treatment can be curative. Our group systematically performs oncological management with immediate penile reconstruction and preservation of the organ (partial penectomy, resurfacing, or glansectomy) when feasible. Due to the low incidence of penile carcinoma, it is difficult to achieve experience in penile reconstruction using free grafts in a standardized and reproducible way. Therefore, we herein present the results of the use of an inanimate model to identify the most efficient geometric way to procure and apply a free skin graft to reconstruct the penis. Methods A preclinical inanimate model of the penis was developed to simulate the surgical reconstruction using a free skin graft. Six different geometric skin-graft models were created and tested. For each of them, we measured graft's surface area as well as the discarded surface after placing the graft on the penis for reconstruction. We also measured the amount of suture lines required for reconstruction. All of these measurements in the six different models were compared. Results Based on the six models, we identified that the longitude of the graft must measure the same as the maximum perimeter of the glans in order to have a square that enables the complete coverage of the penile defect. The total graft area for the first 4 models was of 40 cm2; for models 5 and 6, it was of 60 cm2. The average discarded area of the graft was of 18.135 cm2 (range: 12 cm2 to 30 cm2). Models 4 years 6 were the ones with the least discarded tissue: 12 cm2. The average amount of suture lines to secure the different model grafts was 7.3 (range: 5 to 12). The models that required the least amount of suture lines were number 1 and 4, with a total of 5 suture lines. Conclusions The double trapezoid is the most efficient model to reconstruct the glans after organ-sparing oncological management. Our results contribute to establish a more standardized and predictable technique to reconstruct the penis.

The Use of Fascia Lata Free Graft for Lateral Canthus Reconstruction Following Mohs Lower Lid Surgery

We present a case of a 75-year-old patient who underwent reconstruction of the lower eyelid and lateral canthus following removal of 80% of the lower eyelid due to basal cell carcinoma. A Hughes transconjunctival eyelid-sharing flap was used to form the posterior lamella, and a free skin graft from the ipsilateral upper lid was used to recreate the anterior lamella. The lateral canthal ligament was reconstructed using a free fascia lata graft. A periosteal flap was not used due to local scarring that was the result of previous multiple lateral canthal surgeries. Skin preservation in the lateral canthal area and additional horizontal support for the lower eyelid were achieved by using a local advancement flap. This two-stage surgery produced excellent functional and cosmetic effects. Fascia lata free graft can be an alternative to the periosteal flap for reconstruction of the lateral canthal ligament when use of the lateral orbital periosteum is not feasible.

Reconstrucción del vestíbulo nasal con colgajo libre de piel Nasal - Vestibule Reconstruction with skin free flap

Introducción: Existen complicaciones tempranas y tardías derivadas de cualquier procedimiento quirúrgico; la Rinoplastia, no es una excepción a esta regla; existen complicaciones intraoperatorias, en el postoperatorio inmediato, a mediano y a largo plazo, que pueden afectar tanto la parte estética como la funcional. Objetivo: Presentar un reporte de caso donde se evidencian importantes complicaciones de la rinoplastia y describir la técnica quirúrgica empleada para la reconstrucción del vestíbulo nasal, identificando casos parecidos en la literatura. Diseño: Reporte de caso. Materiales y métodos: Se presenta un caso de una paciente de 62 años con estenosis vestibular bilateral y deformidad nasal posterior a dos rinoplastias y unainfección postoperatoria, con compromiso funcional y estético. En búsqueda de consejería, esta paciente fue presentada en varios congresos internacionales, sin embargo, no se recomendaba intervención. Adicionalmente se presenta una técnica quirúrgica para reconstrucción del vestíbulo nasal usando un injerto libre de piel. Se presentan fotografías del pre-operatorio, la intervención quirúrgica y los resultados del postoperatorio. Resultados: A la fecha, la paciente se encuentra satisfecha y sin secuelas de la intervención o compromiso funcional. Conclusiones: Nuestra técnicaquirúrgica, aparte de mantener el contorno de la narina debido al uso de stent nasal, permite reducir la formación de tejido de cicatrización y la contracción de la herida por parte de los miofibroblastos mediante el injerto libre de piel. Consideramos que esta técnica es reproducible para el manejo de este tipo de complicaciones. Introduction: There are early and late complications arising from any surgical procedure; rhinoplasty is not an exception to this rule, there are intraoperative complications in the immediate postoperative period, medium and long term, which can affect both the aesthetic and functional aspects. Objective: To present a case report where some major complications of rhinoplasty are shown and to describe the surgical technique used for nasal vestibule reconstruction, identifying similar cases pubished in the literature. Design: Case report. Material and methods: We present the case of a 62 year old patient with bilateral vestibular stenosis and nasal deformitysecondary to two rhinoplasties and a postoperative infection. Seeking counseling, this patient was presented at several international conferences, however, no intervention was recommended. Additionally a surgical technique for reconstruction of the nasal vestibule using a free skin graft. Photographs before, during and after surgery are presented. Results: To date, the patient is satisfied without sequelae from the intervention or functional compromise. Conclusions: Our surgical technique, apartfrom maintaining the outline of the nostril due to the use of nasal stent, decreases the formation of scar tissue and wound contraction by myofibroblasts by free skin flap. We believe that this technique is reproducible for the management of these complications.

TREATMENT OF LARGE AND GIANT MELANOCYTIC NEVI OF MAXILLOFACIAL AREA IN CHILDREN

OBJECTIVE. The study determined the choice of treatment method according to morphological structure of large and giant congenital melanocytic nevi of maxillofacial region. MATERIALS AND METHODS. Several options of surgical treatment were applied in 40 children of different age such as local plasty, expander dermotension and transplantation of free skin graft. The features of maxillofacial region were taken into account. RESULTS. The scheme of staged surgical treatment was developed. All the patients had constant positive results. These data were evaluated conside ring choice of surgical treatment and features of morphological structure of removed nevi. CONCLUSIONS. The guidelines of staged surgical treatment developed by authors allowed them to improve the results of patient cure.

Vertical-to-Horizontal Rotational Myocutaneous Flap for Repairing Cicatricial Lower Lid Ectropion: A Novel Surgical Technique

Objective. To evaluate the efficacy and complications of a novel surgical technique for cicatricial lower lid ectropion that uses a vertical-to-horizontal (V-to-H) rotational myocutaneous flap procedure (Tsai procedure). Methods. We performed the V-to-H rotational myocutaneous flap procedure on 20 eyelids in 20 patients with mild to moderate cicatricial lower lid ectropion. A vertical myocutaneous flap was created from the anterior lamella of the vertical pedicle in the lateral third of the lower eyelid. Following a horizontal relaxing incision from the base of the flap, a vertical myocutaneous flap was created and rotated to horizontal. Two patients with combined cicatricial ectropion and paralytic lagophthalmos simultaneously underwent additional lateral tarsorrhaphy. Results. After a minimum follow-up period of 6 months, all patients showed good anatomical and functional improvement with decreased dependence on topical lubricants and a satisfactory cosmetic appearance. Two patients with combined cicatricial and paralytic ectropion had mild residual asymptomatic lagophthalmos. No patients required further revision surgery and there were no complications or recurrence. Conclusion. The V-to-H rotational myocutaneous flap technique was an effective and simple one-stage procedure for correcting cicatricial lower lid ectropion. It lengthened the anterior lamella and tightened horizontal eyelid laxity without the need for a free skin graft.