404 Efficacy and Long-Term Outcomes of Skin Grafts Versus Dorsal Flaps in Syndactyly

Aim Syndactyly is a congenital condition which is commonly resolved around 18-24 months of age using either a full-thickness skin graft or a flap to address the skin shortage in the web-space. The aim is to review and compare the long-term outcomes of these techniques. Method Using medical databases, 673 citations were identified between the years 1966 and 2016 related to simple syndactyly. Of these, 34 were chosen: English-language articles, simple isolated syndactyly, i.e., not syndromic, and procedures using a dorsal-metacarpal advancement flap or skin graft. Outcomes were divided into early post-operative and long-term; earlier outcomes being graft failure and flap necrosis, and long-term outcomes being web creep, scar hypertrophy or contracture, and revision surgery. ORs were calculated to compare rates of complication between the two procedures. Results Early post-operative complications showed a statistically significant difference in incidence; both individual and combined incidence (OR, 9.4; 95% CI, 3.6-24.8; P <.05) were more likely to occur in the graft group. Incidence of web creep, (OR, 12.9; 95% CI, 1.7-96.6; P<.05), contracture (OR, 4.5; 95% CI, 1.4-13.6; P < .05) and scar hypertrophy (OR, 49.3; 95% CI, 1.3-215.0; P < .05) were also statistically significant in comparison of the two techniques and more likely to occur in the graft group. Conclusions While there is data to suggest a superiority in flap procedures, there is a lack of standardization across studies which undermines the power of systematic reviews and hence a uniform classification would improve the quality of existing research.

Large chest keloids treatment with expanded parasternal intercostal perforator flap

Background Chest keloids often converged into a large lesion on the chest in some patients. Such keloids often lead to obstacle to excision and reconstruction. We describe a surgical method for large chest keloids with expanded parasternal intercostal perforator flap (EPIPF). Methods Fifteen patients with chest keloid were treated with EPIPF in our department between August 2017 and Dec 2019. The surgical treatment was divided into two different phases. In the first phase, we implanted skin expanders into the layer under the deep fascia beside the keloids. The expander was expanded every week for about 3–4 months. In the second phase, the expander was removed, the keloid tissue was removed and an expanded perforator flap was then designed to cover the wound. Patients were followed-up after surgery. Complications after surgery were analyzed. Recurrence and the patients, satisfactory rate was recorded. Results Of the 15 patients, one patient complicated with undesirable small area wound healing. 11 were cured without scar hypertrophy or recurrence and four were partially cured with a small portion of scar hypertrophy. Eleven patients thought that the esthetic result was good (73.7%), and 4 patients thought the result was acceptable (26.7%). None patient was dissatisfied. Conclusion EPIPF are effective surgical method for managing large chest keloids. It can offer enough skin flap coverage for keloid wound resurfacing with stable blood supply to assure satisfactory results. Level of evidence Level IV, case series.

Large Chest keloids treatment with expanded parasternal intercostal perforator flap

Background Chest keloids often converged into a large lesion on the chest in some patients. Such keloids often lead to obstacle to excision and reconstruction. We describe a surgical method for large chest keloids with expanded parasternal intercostal perforator flap (EPIPF).Methods Fifteen patients with chest keloid were treated with EPIPF in our department between August 2017 and Dec 2019. The surgical treatment was divided into two different phases. In the first phase, we implanted skin expanders into the layer under the deep fascia beside the keloids. The expander was expanded every week for about 3-4 months. In the second phase, the expander was removed, the keloid tissue was removed and an expanded perforator flap was then designed to cover the wound. Patients were followed-up after surgery. Complications after surgery were analyzed. Recurrence and the patients, satisfactory rate was recorded. Results Of the 15 patients, one patient complicated with undesirable small area wound healing. 11 were cured without scar hypertrophy or recurrence and four were partially cured with a small portion of scar hypertrophy. Eleven patients thought that the esthetic result was good (73.7%), and 4 patients thought the result was acceptable (26.7%). None patient was dissatisfied.Conclusion EPIPF are effective surgical method for managing large chest keloids. It can offer enough skin flap coverage for keloid wound resurfacing with stable blood supply to assure satisfactory results. Level of Evidence: Level IV, case series.

533 Establishment and Effects of a Method for Wound Repair in Patients with Extensive Deep Burns Using Fresh Skin Allografts and Autologous Micrograft

Introduction This study was to establish a method for wound repair in patients with extensive deep burns using fresh allogeneic scalp combined with autologous micrograft. Methods Two patients with burn injuries involving 90% (3rd degree, 70%) and 97% (3rd degree, 85%) total body surface area (TBSA) respectively were treated with fresh scalp allografts donated by 32 males aged (31.5 ± 8.2) years or autologous micrografting. The bilateral limbs with third-degree burns were selected as treatment and control groups. Wounds in the treatment group were treated with fresh allogeneic scalp and autologous micrograft, while wound in the control group received MEEK grafting. Preoperatively, the surgical area on the extremities was calculated to estimate the necessary amount of allogeneic scalp and MEEK grafts. Fresh scalps (0.30 - 0.35 mm) were harvested from each donor to prepare a larger piece of skin allograft. Autologous micrografts were transported onto the epidermis of the skin allograft. The treatment and control group received grafting according to our protocol. The donors received follow-up visits after 3 months to see if there is alopecia and scar hypertrophy. The wound coverage rate was observed in both treatment and control groups on postoperative weeks 2, 3, 4 and 5. Results The donor sites in all allogeneic skin donors healed within 10 days postoperatively. The scalp recovered well without any alopecia or scar hypertrophy during the follow-up visits. The wound coverage rate of the treatment group was approximate to or higher than that of the control group. Conclusions Considering that allogeneic skin is scarce and expensive and the patient’s relatives are willing to help save the patient’s life by donating the scalp, this method may be a feasible clinical treatment option. Applicability of Research to Practice This study is a clinical study which is highly applicable in practice.

Pedicled Oblique Para-Umbilical Perforator (OPUP) Flap for Upper Limb Reconstruction

Background: Groin flap has been considered the workhorse flap for hand reconstruction. However it has certain drawbacks when covering defects over elbow or proximal forearm. Pedicled oblique paraumbilical perforator (OPUP) based flaps provide a good alternative in such cases. Methods: We performed OPUP flap in 11 cases of complex upper limb reconstructions over the past one year. We report our experience with this flap. Results: All flaps survived. One patient had marginal necrosis of 1 cm in the proximal end after flap division. Three patients had donor site scar hypertrophy. Conclusions: OPUP flap is superior to groin flap for larger defects or defects around the elbow. The major disadvantage is the donor site scar which is prone to hypertrophy.