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Annals of Anatomy = Anatomischer... May 2020Existing epidermal transplantation procedures applied in burn surgery or wound treatment, such as mesh grafting or the Meek method, do not lead to a restoration of all...
Existing epidermal transplantation procedures applied in burn surgery or wound treatment, such as mesh grafting or the Meek method, do not lead to a restoration of all the skin layers. Dermal skin layers are indispensable in ensuring the quality and function of the transplanted skin as a frictional surface and a carrier of skin appendages such as hair, sweat glands, and sebaceous glands, as well as nerve receptors for detecting pressure, vibration, and temperature. Because of the restricted skin surface area that can be provided by the donor, full-skin transplants cannot be transplanted over a large area. Cultured skin procedures, based on skin cells cultivated in a laboratory, have not yet reached a stage of development where a complex full epidermal transplantation is possible. In particular, the introduction of skin appendages with a functional cell-to-cell communication has not been observed thus far in cultivated skin. Based on the Reverdin transplantation method, in which concave skin islands with epidermal and dermal parts are transplanted, Davis in 1910 described the transplantation of multiple 2-5 mm sized full-skin islands as a new method for the treatment of skin lesions. Further modifying this 100-year-old procedure, we developed a miniaturization and automation of the Davis transplantation method that started in 2011 and called it "SkinDot". In the following article we describe the effectiveness of the full-skin island transplant procedure in two patients. The transplantation of single 2-3 mm full-skin islands results in a full-skin equivalent without any limits on donor area and with a reduced donor morbidity.
Topics: Biopsy, Needle; Burns; Humans; Skin Transplantation; Transplantation, Autologous
PubMed: 31899297
DOI: 10.1016/j.aanat.2019.151454 -
Acta Chirurgica Belgica Aug 2022Early surgical debridement of the deep second and third-degree burns is still the standard of care (SOC) to prepare the wound bed for skin grafting. However, this... (Review)
Review
INTRODUCTION
Early surgical debridement of the deep second and third-degree burns is still the standard of care (SOC) to prepare the wound bed for skin grafting. However, this technique has some drawbacks that explain the growing interest in enzymatic debridement as an alternative. In this article, we provide a historic overview as well as the current state-of-the-art and future prospective of this type of non-surgical debridement.
MATERIALS AND METHODS
A narrative review of the available literature was conducted using a systematic search.
RESULTS
A total of 32 articles were included. The only enzyme mixture still used nowadays for burn eschar removal is bromelain-based. There is increasing evidence that this type of enzymatic debridement is a powerful tool to selectively remove the eschar in deep burns, thereby reducing the need for autologous skin grafting compared to surgical SOC. Moreover, off-label use of enzymatic debridement with NexoBrid (facial, pediatric, and >15%TBSA burns) has proven to be effective and safe.
CONCLUSION
There is increasing evidence that bedside administered NexoBrid, preferably under regional anesthesia, is a powerful tool for selective burn eschar removal. However, the clinical wound bed evaluation post-NexoBrid procedure in relation to the optimal treatment decision-conservative treatment surgery-is not yet completely elucidated. More high-quality prospective clinical trials are necessary to compare enzymatic debridement of objectively confirmed deep burns with the current standard treatment and assess the effectiveness of the eschar removal, the need for surgery, the healing time of such wounds, and the long-term scar quality.
Topics: Burns; Child; Debridement; Humans; Skin; Skin Transplantation; Wound Healing
PubMed: 35440290
DOI: 10.1080/00015458.2022.2068746 -
European Journal of Orthopaedic Surgery... Feb 2019The lateral arm flap (LAF) is a popular flap transfer, which can be applied in many procedures. It was first described in 1982, and till then, even more clinical... (Review)
Review
The lateral arm flap (LAF) is a popular flap transfer, which can be applied in many procedures. It was first described in 1982, and till then, even more clinical applications are suggested. It can be used as a free fasciocutaneous or fascial flap to cover small- to medium-sized soft tissue defects in head and neck but also in upper and lower extremity reconstruction, or as an osteocutaneous flap when vascularized bone graft is needed. We present the indications and contraindications, the advantages and disadvantages, as well as the step-by-step technique of harvesting a fasciocutaneous and an osteocutaneous flap and its complications. We conclude that the LAF is a reliable and versatile tool for reconstructive surgery, due to its anatomical characteristics and the low complication rate.
Topics: Arm; Bone Transplantation; Contraindications, Procedure; Equipment Design; Humans; Microsurgery; Skin Transplantation; Surgical Flaps; Tissue and Organ Harvesting; Transplant Donor Site
PubMed: 30649619
DOI: 10.1007/s00590-019-02363-0 -
Clinics in Plastic Surgery Jul 2024Acute burn reconstruction involves intricate strategies such as skin grafting and innovative technologies, addressing challenges in coverage and minimizing donor site... (Review)
Review
Acute burn reconstruction involves intricate strategies such as skin grafting and innovative technologies, addressing challenges in coverage and minimizing donor site morbidity. Despite being rarely used, flap reconstruction becomes necessary when critical structures are exposed, offering robust coverage and reducing complications. However, free flaps in acute burns face challenges, including a higher failure rate attributed to hyperinflammatory states and hypercoagulability. Surgical optimization strategies involve careful timing, patient preparation, and meticulous postoperative care. In delayed burn reconstruction, free flaps proved effective in functional and aesthetic restoration, with low flap loss rates and minimal contracture recurrence. Prefabricated and prelaminated flaps emerged as a solution for complex cases, ensuring the best functional and aesthetic possible outcomes in challenging facial burn reconstructions.
Topics: Humans; Burns; Microsurgery; Plastic Surgery Procedures; Free Tissue Flaps; Skin Transplantation
PubMed: 38789149
DOI: 10.1016/j.cps.2024.02.005 -
Facial Plastic Surgery Clinics of North... May 2020
Topics: Alopecia; Cosmetic Techniques; Hair; Humans; Plastic Surgery Procedures; Skin Transplantation
PubMed: 32312512
DOI: 10.1016/j.fsc.2020.02.001 -
Archives of Dermatological Research Dec 2023Vitiligo manifests as depigmented macules and patches on the skin and can significantly impact a patient's quality of life. Despite the availability of several treatment... (Review)
Review
Vitiligo manifests as depigmented macules and patches on the skin and can significantly impact a patient's quality of life. Despite the availability of several treatment modalities, rates of repigmentation can vary widely among individuals and disease subtypes. For patients with stable vitiligo who have not achieved satisfactory results with medical treatments, the melanocyte-keratinocyte transplantation procedure (MKTP) is a viable option. While variations of this autologous non-cultured cellular grafting procedure are performed by dermatologic surgeons worldwide and has shown good tolerability and effectiveness, it remains under utilized in the United States. We present a comprehensive overview of MKTP, highlighting evidence-based and practical techniques to enhance patient outcomes. By serving as a valuable resource, this review aims to support dermatologic surgeons seeking to incorporate MKTP into their practice and promote awareness regarding its benefits, ultimately fostering a more comprehensive approach to vitiligo care.
Topics: Humans; Vitiligo; Quality of Life; Keratinocytes; Skin; Melanocytes; Treatment Outcome; Skin Transplantation
PubMed: 38038734
DOI: 10.1007/s00403-023-02761-9 -
Journal of Cosmetic Dermatology Nov 2022The nail apparatus is the largest and most complex skin appendage. Defects in this unit can result in significant functional insufficiency and cosmetic disfigurement.... (Review)
Review
The nail apparatus is the largest and most complex skin appendage. Defects in this unit can result in significant functional insufficiency and cosmetic disfigurement. Common nail deformities include split nail, short nail, onycholysis, nail malalignment, hooked nail, and absent nail. Currently, surgical repair is the primary treatment for such deformities. Based on the etiological and anatomical classifications, one or more appropriate operations can be selected to repair nail unit deformities. These include autologous fat grafting, longitudinal cicatrectomy, Z-plasties, nail bed elongation, split-thickness sterile matrix grafting, volar V-Y advanced flap reconstruction, sterile matrix particle grafting, germinal matrix flaps, and germinal matrix grafting. This review discusses the fundamental classification of nail unit deformities, common reconstructive surgical techniques, and their features.
Topics: Humans; Surgical Flaps; Nails; Plastic Surgery Procedures; Nail Diseases; Skin Transplantation
PubMed: 35770304
DOI: 10.1111/jocd.15198 -
Journal of Orthopaedic Trauma Jul 2015
Topics: Humans; Negative-Pressure Wound Therapy; Skin Transplantation; Wounds and Injuries
PubMed: 26091528
DOI: 10.1097/BOT.0000000000000260 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jul 2023To summarize the research progress of surgical technique and immunosuppressive regimen of abdominal wall vascularized composite allograft transplantation in animals and... (Review)
Review
OBJECTIVE
To summarize the research progress of surgical technique and immunosuppressive regimen of abdominal wall vascularized composite allograft transplantation in animals and clinical practice.
METHODS
The literature on abdominal wall transplantation at home and abroad in recent years was extensively reviewed and analyzed.
RESULTS
This review includes animal and clinical studies. In animal studies, partial or total full-thickness abdominal wall transplantation models have been successfully established by researchers. Also, the use of thoracolumbar nerves has been described as an important method for functional reconstruction and prevention of long-term muscle atrophy in allogeneic abdominal wall transplantation. In clinical studies, researchers have utilized four revascularization techniques to perform abdominal wall transplantation, which has a high survival rate and a low incidence of complications.
CONCLUSION
Abdominal wall allotransplantation is a critical reconstructive option for the difficulty closure of complex abdominal wall defects. Realizing the recanalization of the nerve in transplanted abdominal wall to the recipient is very important for the functional recovery of the allograft. The developments of similar research are beneficial for the progress of abdominal wall allotransplantation.
Topics: Animals; Abdominal Wall; Vascularized Composite Allotransplantation; Transplantation, Homologous; Skin Transplantation; Hematopoietic Stem Cell Transplantation
PubMed: 37460189
DOI: 10.7507/1002-1892.202302077 -
Plastic and Reconstructive Surgery Mar 2018After studying this article, the participant should be able to: 1. Understand how to determine nipple-areola complex positioning on the reconstructed breast. 2....
LEARNING OBJECTIVES
After studying this article, the participant should be able to: 1. Understand how to determine nipple-areola complex positioning on the reconstructed breast. 2. Understand the multitude of local flap and distant graft options for nipple-areola complex reconstruction. 3. Draw at least three fundamental nipple-areola complex reconstruction patterns. 4. Understand the forces that are responsible for flattening of the reconstructed papule. 5. Understand the current techniques used in secondary nipple-areola complex reconstructions.
SUMMARY
Nipple-areola complex reconstruction and tattooing represent the final two stages of breast reconstruction. Nipple-areola complex reconstruction is typically accomplished with the use of local flaps, local flaps with augmentation grafts, or a combination thereof. Regardless of the technique used, however, all nipple-areola complex reconstructions lose a degree of projection over time. Options for secondary reconstruction include the use of local tissue flaps alone or in combination with acellular biological matrices.
Topics: Female; Humans; Mammaplasty; Nipples; Skin Transplantation; Surgical Flaps; Tattooing
PubMed: 29481412
DOI: 10.1097/PRS.0000000000004166