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.

SP5.2.5 A 4-year single-centre cohort study assessing outcomes in vascular surgery patients undergoing calf fasciotomies

Aims Acute compartment syndrome (ACS) is a surgical emergency. Delayed diagnosis and fasciotomy can result in irreversible muscle necrosis causing permanent disability and major amputation. This study compared patient outcomes following calf fasciotomies to prevent ACS (prophylactic) versus treat ACS (therapeutic) and early (within 6 hours of ACS diagnosis) versus delayed fasciotomies (beyond 6 hours) at a single vascular centre. Methods All patients undergoing calf fasciotomies between 1st January 2017 and 31st December 2020 were identified from a prospectively collected departmental database. Caldecott-approved data collection was conducted. The primary outcomes were wound infection, foot drop, muscle debridement, split-skin graft (SSG) requirement, vacuum dressing, 30-day amputation and death rates. Statistical analysis was performed using Fisher’s exact test. Results 73 patients (51 men, 22 women; median age 67, IQR 56-75 years) underwent calf fasciotomies (44 therapeutic and 29 prophylactic) mainly following acute thromboembolic ischaemia. Higher complication rates occurred among delayed (15) versus early (29) fasciotomy patients: wound infection (13.3% vs 3.4%), foot drop (20.0% vs 3.4%), muscle debridement (40.0% vs 24.1%), loss of anterior compartment (13.3%, 3.4%) need for SSG (29.5% vs 17.2%), vacuum dressing (46.7% vs 20.7%) and 30-day amputation rate (20.0% vs 13.8%) but lower 30-day death rate 13.3% vs 17.2%). None of these results were statistically significant. 34.1% of delayed fasciotomies were due to awaiting emergency theatre availability. Conclusion ACS patients undergoing calf fasciotomies are at high risk of complications including amputation and death. Ongoing education on mortality risk and early communication with emergency theatres are critical in their management.

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.

Tissue Engineered Successful Reconstruction of a Complex Traumatized Lower Extremity

Introduction: Tissue engineered reconstruction is a minimally invasive approach for healing major complex wounds successfully. It combines accurate, conservative debridement with a specially adapted suction method, platelet-rich plasma (PRP) injections, and biomaterial application to salvage injured tissues and grows new soft tissues over wounds. Case Report: A healthy young man in his early 30s presented to our emergency department with complex knee-thigh injuries following a high-velocity automobile accident. Degloved anterolateral thigh, severe thigh muscle injuries, and ruptured extensor patellar mechanism were observed. Accurate conservative (as opposed to radical) debridement and PRP injections salvaged the injured muscles and tendons. Specially carved reticulated foam wrapped around the injured ischemic muscles, followed by low negative, short intermittent, cyclical suction therapy. Wound exploration 4 days apart revealed progressive improvements with considerable vascularization of the injured soft tissues within 2 weeks. Thereafter, meticulous reconstruction of the salvaged muscles and tendons restored anatomical congruity. An absorbable synthetic biomaterial covered the sizeable open wound with vast areas of exposed tendons. Five weeks later, exuberant granulating tissue ingrowth within the biomaterial filled up the tissue defect. A split-skin graft covered the remaining raw areas, which “took” completely. Early rehabilitation enabled the patient to return to active work, play contact sports, and perform strenuous activities effortlessly. Conclusion: Minimally invasive tissue engineered reconstruction is a novel approach using a series of simple minimally invasive procedures. It lessens the duration of surgery and anesthesia, maximizes soft-tissue salvage, lowers morbidity, minimizes hospitalization, saves costs, and improves the patient’s quality of life significantly. Keywords: Mangled extremity, Limb salvage, Financial, Trauma, Modified negative pres

955 Management of A Progressed SCC Case in the COVID-19 Era

We herein report the case of an elderly patient who underwent amputation of their hand for a squamous cell carcinoma (SCC) due to lack of timely treatment during the COVID-19 pandemic. The patient had a biopsy-proven SCC of the dorsum of their left hand, first diagnosed in March 2020, before the first lockdown. The lesion was 3cm, mobile, easily excisable, and the defect routinely reconstructable. Unfortunately, a number of appointments were missed and when the patient was eventually seen back in the clinic, the lesion was bigger and firmly fixed to the deeper structures. An urgent wide excision of the lesion with split skin graft reconstruction was planned. Intraoperatively, axillary lymph nodes were identified and a FNAB reported metastatic disease. After a failed attempt to fully resect the hand lesion and salvage the surrounding structures, a joint consultant decision was made that an amputation would give the patient the best chance of survival. Since the patient was lacking capacity, and following a discussion with the family, an above wrist amputation was performed in the patient’s best interests. This case sheds light on the unseen and unrecorded victims of COVID-19. Due to the pandemic, most outpatient follow-up appointments were cancelled, and operating waiting times were significantly increased. National research studies showed that all skin cancer treatments were negatively affected by the COVID-19 pandemic. During this lockdown, there is an urgent need to continue the provision of these services as the risk of untreated skin cancer is even greater.