Skin and composite grafts

Skin grafts may be used for coverage of facial defects in situations in which alternative methods of reconstruction, such as local flaps, are not an option. They may also be beneficial for patients who wish to avoid or who are not good candidates for more complex reconstruction. Full-thickness skin grafts often have a better color and texture match to adjacent skin when compared to split-thickness grafts; however, split-thickness grafts have lower metabolic demand and increased survival rate. Composite grafts may be very useful in the repair of defects with unique contour and support requirements, such as the nasal ala and eyelid. With all grafts, thoughtful planning and sound surgical technique are critical in achieving the best possible functional and aesthetic result.

Usefulness of Local Flaps for Scar Contracture Release

Local flaps are useful for reconstructing scar contractures on mobile areas such as joints, the neck, the axilla, the digital web, and the mouth commissure. They are superior to skin grafts because the latter can contract, thereby leading to secondary contractures. Moreover, the color and texture match of local flaps is better than that of grafted skin. Consequently, local flaps generally provide superior aesthetic outcomes. Thus, if there is healthy skin adjacent to the scar contracture, local flaps should be the first choice. In terms of local flap selection, it is necessary to choose between a skin-pedicled flap and an island flap. We showed recently that 6 months after surgery, skin-pedicled flaps associate with greater scar extension rates than island flaps. Thus, local flaps, especially skin-pedicled flaps, elongate the scar as effectively as z-plasty. It should be noted that if the scar is large, it is effective only by dividing the scar with the local flap. However, the flap size can be slightly smaller than the deformity size (although how much smaller depends somewhat on how extensible the flap type is): it is not necessary that the flap is as big as the open wound after scar division or scar removal.

Gingival Fenestration: A Multidisciplinary Approach

Gingival fenestration is rarely encountered clinical situation causing problems like root sensitivity, root caries and aesthetic problem. Although rare, this situation can be difficult to manage and needs multidisciplinary approach. This case report describes management of gingival fenestration defect with root exposure and endodontic lesion in upper left lateral incisor using multidisciplinary approach. Endodontic treatment followed by double papilla flap technique as coverage of gingival fenestration and finally crown was prosthetically rehabilitated. The result of this case with double papilla graft technique demonstrated satisfactory healing of the gingival fenestration defect with excellent colour and texture match with the surrounding tissues.

Skin grafting after paediatric palmar burns: an analysis of 82 patients

Contact burn injuries to the palm are common in toddlers. We report a case series of 82 paediatric patients (age 7–48 months) with contact burn injury of the palm. We share our experience and outcomes of using plantar split-thickness skin grafts for resurfacing of the paediatric palm. We found that despite the excellent colour and texture match, split-thickness skin grafts from glabrous skin during growth are prone to motion-limiting scare contracture. From this series, we conclude that full-thickness skin grafts remain the reference standard of care in paediatric patients’ hands. We recommend that children with burn scars should have regular check-up examinations until they are fully grown. Level of evidence: IV

Local facial flaps: a workhorse for reconstruction of facial malignancies defects

<p class="abstract"><strong>Background:</strong> Face represents complete personality of a human being, so adequate cosmetic correction of facial defects arising due to skin malignancy is very important. After excision, treatment option varies according to size and location of defect for small- or moderately-sized circular defects. In our study, we have evaluated versatility of local flap of face.</p><p class="abstract"><strong>Methods:</strong> We have included 30 cases of skin malignancy on face in our Institute within the period of June 2016 to May 2018. 20 patients (66.6%) were male and 10 patients (33.3%) were female, in age group from 45 to 65 years. 17 cases had basal cell carcinoma, 10 cases had squamous cell carcinoma and 3 cases had malignant melanoma. Tumours were excised with safe margins and defects reconstructed with local facial flaps. We evaluated the early postoperative complications and after 6months, cosmetic outcome and patient satisfaction was evaluated. </p><p class="abstract"><strong>Results:</strong> 30 patients with small to medium-sized defect (3-6 cm), 8 cases were managed with V-Y advancement flap, 7 cases nasolabial flap, 8 cases forehead flap and, 4 cases Limberg flap, 4 cases cheek advancement flap. Postoperatively none of the cases had complications and the functional and aesthetic outcomes were quite acceptable. Aesthetic results were excellent in 15 patients (50%), while in 8 patients good results (27%) and 5 patient fair results (17%) after 6 month.</p><p class="abstract"><strong>Conclusions:</strong> Local facial flaps are the simple and best option to reconstruct the small to medium size facial malignancies defects and provides excellent skin colour and texture match with gives good aesthetic result.</p>

Hypothenar island flap: A safe and excellent choice for little finger defects

ABSTRACTSoft-tissue defects of the little finger are challenging especially when bone, tendon or vascular pedicle is exposed because of trauma. The hypothenar island flap is easy to harvest and has a good colour and texture match to the little finger pulp. We present nine clinical cases of soft tissue defects of the little finger covered using the reversed hypothenar fasciocutaneous island flap. This article intends to highlight the ease of elevation and good clinical results of the hypothenar flap which is rarely used.

A study of the use of the supraclavicular artery flap for resurfacing of head, neck, and upper torso defects

ABSTRACTThe head and neck region is an aesthetically demanding area to resurface because of its high visibility. Tissue defects in this area often require distant flaps or free flaps to achieve an aesthetically acceptable result. The use of the Supraclavicular artery flap represents an extremely versatile and useful option for the resurfacing of head, neck and upper torso defects. Furthermore, islanding the flap gives it a wide arc of rotation and the color and texture match is superior to that of free flaps harvested from distant sites. In our study, we used the flap (both unexpanded and expanded) predominantly for resurfacing neck defects resulting from the release of post-burn contractures. However, its applicability in other indications would also be similar. Except one, all our flaps survived almost completely and the post-operative morbidity was very low. We conclude that the supraclavicular artery flap not only provides a reasonably good color and texture match but also maintains the multi-directional activity in the neck region.

Reconstruction of the Columella with Bilateral Nostril Sill Flaps

The treatment of total columellar defects is very difficult, and there is not any first choice in reconstruction of these defects. Various techniques have been reported for this purpose. Each technique has its own drawbacks, and few can be performed in one stage. We report a pediatric patient with a defect involving the entire columella. Reconstruction of the defect was accomplished with laterally based bilateral nostril sill flaps. An acceptable cosmetic result was obtained. This method can be done as a single-stage operation with an excellent color and texture match. We think that this method leads to good aesthetic results, and should be considered for total columellar reconstruction.