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Der Hautarzt; Zeitschrift Fur... May 2022Microsurgical autologous hair transplantation, when performed as follicular unit transplantation, may permanently and naturally improve advanced androgenetic alopecia in... (Review)
Review
BACKGROUND AND OBJECTIVES
Microsurgical autologous hair transplantation, when performed as follicular unit transplantation, may permanently and naturally improve advanced androgenetic alopecia in men and women and also non-active scarring alopecias.
MATERIALS, METHODS AND RESULTS
Sufficient donor hair and realistic patient expectations as well as an individual surgical planning of the hair distribution are crucial prerequisites for a sustainable hair restoration. They should be determined and evaluated during a personal pre-examination and consultation with the hair surgeon. Natural results can be achieved by transplanting up to several thousands of follicular units with high densities into small micro-slits. This technique also allows for increasing the hair density without injuring surrounding original pre-existing hairs. In progressive, early or advanced androgenetic alopecia, additional medical therapy is highly recommended to stabilize the condition. Otherwise, depending on supply and demand of donor hair, only a partial hair restoration can be achieved with a satisfying density.
CONCLUSIONS
Since hair transplantation requires a precise sequence of surgical steps and careful handling of the tiny grafts, the skills and experience of the hair surgeon and his or her team are crucial. The medical risks of an assembly-line way of performing this surgery by non-licensed, non-physician staff, as reported from national clinics and medical tourism, should not be underestimated. The German Association of Hair Surgeons and the International Society of Hair Restoration Surgery offer patient information, as well as continuous medical education and guidelines for interested physicians to ensure the highest quality standard of care.
Topics: Alopecia; Female; Hair; Hair Follicle; Humans; Male; Skin Transplantation; Surgeons
PubMed: 35428954
DOI: 10.1007/s00105-022-04985-8 -
Journal of Wound Care Jul 2021
Topics: Humans; Leg Injuries; Skin Transplantation
PubMed: 34256603
DOI: 10.12968/jowc.2021.30.7.516 -
Revue Medicale Suisse Mar 2022Chronic ulcers are a common but important dermatological problem and a major source of expense in the western countries. Skin graft is a surgical procedure in which skin... (Review)
Review
Chronic ulcers are a common but important dermatological problem and a major source of expense in the western countries. Skin graft is a surgical procedure in which skin or skin substitute is transplanted in order to close a wound. This article aims to review the different categories of grafts, their indications for the healing of chronic ulcers of the lower limbs, emphasizing the position of punch grafts in the treatment arsenal.
Topics: Humans; Leg Ulcer; Skin Diseases; Skin Transplantation; Ulcer; Wound Healing
PubMed: 35353456
DOI: 10.53738/REVMED.2022.18.775.604 -
Journal of Investigative Surgery : the... Dec 2023Perifascial areolar tissue (PAT) is an areolar layer over the muscle fascia. PAT has been shown to be resistant to ischemia and prone to survival even in ischemic... (Review)
Review
BACKGROUND
Perifascial areolar tissue (PAT) is an areolar layer over the muscle fascia. PAT has been shown to be resistant to ischemia and prone to survival even in ischemic conditions. PAT grafts provide a vascular tissue layer on necrotic bone and tendons where skin grafting is not possible. The effect of PAT grafting on burn reconstruction has not yet been reported. Thus, in this study, we aimed to present our experience and discuss the role of PAT grafting in extremity burn reconstruction.
METHODS
Between January 2019 and December 2020, 16 PAT grafting procedures were performed in 11 patients. All patients had second- or third-degree burns in the upper and lower extremities, with exposed bone or tendon. PAT grafts were harvested from the abdominal region and were used for the upper extremity in 7 patients and the lower extremity in 4 patients. Immediate skin grafting was performed during the same session.
RESULTS
The patients' mean age was 50.7 years; defect size, 3.3 × 3 cm; and follow-up time, 11.8 months. The survival rates of the PAT and skin grafts were 93.8% and 68.6%, respectively. Partial skin graft losses were encountered in 4 patients, and total skin graft loss was seen in 1 patient.
CONCLUSION
PAT grafting is an alternative method to the use of dermal substitutes and flap surgery in small-to-medium-sized defects with exposed bone and tendon in burn patients.
Topics: Humans; Middle Aged; Surgical Flaps; Skin Transplantation; Burns; Tendons; Lower Extremity; Treatment Outcome
PubMed: 37004999
DOI: 10.1080/08941939.2023.2192786 -
The Laryngoscope Sep 2022To quantify the degree of color match achieved during microvascular facial reconstruction, and to describe a novel technique for improving reconstructive skin color...
OBJECTIVES/HYPOTHESIS
To quantify the degree of color match achieved during microvascular facial reconstruction, and to describe a novel technique for improving reconstructive skin color match. We hypothesize that split-thickness skin grafts (STSG) placed atop de-epithelialized free tissue produces better facial skin color match than free tissue with intact epithelium.
STUDY DESIGN
Cross sectional photographic study of reconstructed facial skin color match.
METHODS
Sixty-eight adults, who underwent head and neck reconstructive surgery, were divided into six categories based on cutaneous reconstructive technique: cervicofacial flap, radial forearm free flap (RFFF), fibula free flap, anterolateral thigh free flap (ALT), STSG over adiopofascial flap (STAFF), and STSG over myogenous flap (STMF). Averaged color samplings of the reconstructed defect and adjacent normal skin were taken from digital photographs. The color difference was calculated using the delta-E calculation. Blinded expert observers also rated the degree of color match. Nonparametric cohort contrast and correlation statistical analyses were performed.
RESULTS
The mean delta-E's and 10-point Likert ratings for the ALT, fibula, RFFF, STAFF, STMF, and cervicofacial flaps were 11.6, 10.0, 7.7, 6.3, 8.8, and 4.7, and 5.1, 6.4, 2.4, 3.2, 2.7, and 1.1, respectively. Likert scale inter-rater correlation was strong, with coefficient = 0.80.
CONCLUSIONS
On average, STSG over de-epithelialized myogenous and adipofascial free tissue transfers produced a better color match than the skin paddles of donor sites, with the exception of the radial forearm donor site. Delta-E values obtained from photos correlated well with expert ratings of color match. This reliable technique for quantifying color match may be used in future studies.
LEVEL OF EVIDENCE
3 Laryngoscope, 132:1753-1759, 2022.
Topics: Adult; Cross-Sectional Studies; Free Tissue Flaps; Humans; Plastic Surgery Procedures; Skin Pigmentation; Skin Transplantation
PubMed: 34904721
DOI: 10.1002/lary.29959 -
Dermatology Online Journal Sep 2021Management of post-operative soft-tissue defects on the lower legs is challenging owing to arterial and venous insufficiency, poor skin quality including epidermal and... (Review)
Review
Management of post-operative soft-tissue defects on the lower legs is challenging owing to arterial and venous insufficiency, poor skin quality including epidermal and dermal atrophy, insufficient tissue laxity, and increased risk of infection. This paper highlights the management of post-operative soft-tissue defects on the lower extremity that cannot be closed primarily or by reconstruction with a local flap. A systematic review of the literature was performed using the National Library of Medicine (NLM) PubMed online database. Articles were included if they reported the management of post-operative lower extremity soft-tissue defects with secondary intention healing, full-thickness skin graft, split-thickness skin grafts, or skin substitutes. Sixty-three articles were included for analysis. There are several options for managing surgical defects on the lower legs and the method chosen should depend on various factors, including the quality of the skin, vascularity and size of the defect, medical history of the patient, and the experience of the surgeon.
Topics: Bioengineering; Humans; Lower Extremity; Postoperative Complications; Plastic Surgery Procedures; Skin Transplantation; Skin, Artificial; Therapy, Soft Tissue; Wound Healing
PubMed: 34755973
DOI: 10.5070/D327955112 -
Wounds : a Compendium of Clinical... Jun 2022Dermal regeneration matrices (DRMs) represent a significant advance in wound treatment, but their use remains limited because of high associated costs. Used correctly,...
INTRODUCTION
Dermal regeneration matrices (DRMs) represent a significant advance in wound treatment, but their use remains limited because of high associated costs. Used correctly, DRMs help improve aesthetic and functional results of skin-grafted areas.
OBJECTIVE
This case series reports the use of a DRM of 1-mm and 2-mm thickness in the management of acute complex wounds.
MATERIALS AND METHODS
This is a retrospective analysis of a cohort of patients treated between 2015 and 2018. Complex wounds were defined as those with extensive loss of skin and subcutaneous tissue, or as those in critical areas, that required sequential and specialized treatment. Management of acute wounds involved debridement of devitalized tissue, wound bed preparation, DRM implantation, and split-thickness skin grafting (STSG). Negative pressure wound therapy (NPWT) was used in all cases preoperatively, after DRM implantation, and after STSG. Results of integration of DRM and skin grafts were subjectively evaluated. The Vancouver Scar Scale was used to evaluate results 12 months postoperatively.
RESULTS
Traumatic injuries were the most common etiology, and the extension of the treated wounds varied between 4 cm × 5 cm to 42 cm × 28 cm, in the greatest dimensions. A 2-mm-thick matrix was used in 14 cases, with skin grafting after 7 to 9 days. In 6 cases, a 1-mm-thick matrix was used, immediately followed by skin grafting. Negative pressure wound therapy was used in all cases. Dermal regeneration matrices and skin graft integration rates of almost 100% were achieved in all cases. No complications occurred.
CONCLUSIONS
The results showed use of DRM and NPWT was a good reconstructive option in the management of acute complex wounds that required STSG. With proper patient selection, such treatment is an important tool in the armamentarium of reconstructive procedures.
Topics: Humans; Negative-Pressure Wound Therapy; Plastic Surgery Procedures; Retrospective Studies; Skin Transplantation; Treatment Outcome; Wound Healing
PubMed: 35881424
DOI: 10.25270/wnds/2022.154158 -
Analytical Cellular Pathology... 2022Post-burn hypertrophic scars commonly occur after burns. Studies that compare dermal substitutes with other treatment methods are insufficient. The purpose was to...
BACKGROUND
Post-burn hypertrophic scars commonly occur after burns. Studies that compare dermal substitutes with other treatment methods are insufficient. The purpose was to analyze the histopathological differences in hypertrophic burn scars after Matriderm®+split-thickness skin graft (STSG) and compare with AlloDerm®+STSG, STSG, full-thickness skin graft (FTSG), and normal skin.
METHODS
Samples of unburned, normal skin and deep 2 or 3 degree burns were obtained from patients who experienced a burn injury in the past to at least 6 months before biopsy, which was performed between 2011 and 2012. All subjects received >6 months of treatment before the biopsy. Intervention groups were normal (63), STSG (28), FTSG (6), Matriderm® (11), and AlloDerm® (18). Immunohistochemical analyses of elastin, collagen I, collagen III, cluster of differentiation 31 (CD31), smooth muscle actin (-SMA), and laminin from scar and control tissues were performed and compared.
RESULTS
-SMA vascular quantity and vessel width, stromal CD31, and basement membrane laminin expression were not significantly different between normal and intervention groups. Matriderm® group showed no significant difference in elastin, collagen III, stromal CD31 and -SMA, CD31 vessel width, stromal -SMA, vessel quantity and width, and laminin length compared to the normal group, meaning they were not significantly different from the normal skin traits.
CONCLUSION
Dermal substitutes may be an optimal alternative to address the cosmetic and functional limitations posed by other treatment methods.
Topics: Burns; Cicatrix; Humans; Skin Transplantation; Skin, Artificial
PubMed: 35251908
DOI: 10.1155/2022/3686863 -
American Journal of Otolaryngology 2022Acellular dermal matrices (ADMs) have been studied extensively in the literature and have gained popularity for various reconstructive and aesthetic purposes. ADMs are... (Review)
Review
Acellular dermal matrices (ADMs) have been studied extensively in the literature and have gained popularity for various reconstructive and aesthetic purposes. ADMs are composed of a basement membrane and acellular dermal layer of collagen and provide a platform for mucosal epithelization and neovascularization. Combining dermal collagen and essential growth factors allows ADMs to support adequate wound healing and bolster soft-tissue repairs. These dermal matrices can be derived from human cadaveric donor skin (allogenic) or mammalian donor sources (xenogeneic). These dermal substitutes provide the benefit of reducing or eliminating the need for autologous tissue grafts and subsequently minimize donor site morbidity. Many ADMs are currently available in the market, each with variations in processing, manufacturing, storage, preparation, and use. The literature validating ADMs in the head and neck for both cosmetic and reconstructive purposes is evolving rapidly. This review aims to provide an up-to-date and comprehensive overview of the principles of acellular dermal matrices (ADMs), the different types of ADMs, and evaluate common indications, techniques, and outcomes pertaining to select anatomic sites in the head and neck reconstruction.
Topics: Acellular Dermis; Biological Products; Cosmetic Techniques; Head; Humans; Neck; Plastic Surgery Procedures; Skin Transplantation; Wound Healing
PubMed: 34537508
DOI: 10.1016/j.amjoto.2021.103233 -
Clinics in Plastic Surgery Jul 2024Reconstruction of burns in the head and neck region is challenging. This is because it must achieve both functional reconstruction and esthetic reconstruction. Local... (Review)
Review
Reconstruction of burns in the head and neck region is challenging. This is because it must achieve both functional reconstruction and esthetic reconstruction. Local flaps are best for minor defects, particularly in the case of deep burns, because they bear the correct texture and color. However, for large deep burn wounds, simple grafting or small local flaps will not produce satisfactory results. It is also crucial to assess the extent and depth of reconstruction that is needed throughout the face-neck-anterior chest region, and to make the choice between techniques such as Z-plasty, skin grafting, super-thin flaps, and free flaps.
Topics: Humans; Burns; Facial Injuries; Neck Injuries; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps
PubMed: 38789148
DOI: 10.1016/j.cps.2024.02.003