-
Journal of the American Academy of... Feb 2023
Topics: Humans; Wound Healing; Leg Ulcer; Skin Transplantation
PubMed: 30831149
DOI: 10.1016/j.jaad.2019.02.060 -
Zhonghua Shao Shang Za Zhi = Zhonghua... Jan 2021For the wounds caused by burns and other various reasons, the key of therapy is to close the open wounds in time by surgical operation. One of the most important methods... (Review)
Review
For the wounds caused by burns and other various reasons, the key of therapy is to close the open wounds in time by surgical operation. One of the most important methods is autologous skin grafting. However, for large area and long-term chronic trauma, the lack of autologous skin makes the treatment a huge challenge. For this reason, clinical medical workers have gradually developed miniature free skin grafting through continuous research. This paper reviews the relevant skin grafting techniques, including pinch free skin grafting, stamp free skin grafting, meek grafting, microne free skin grafting, etc.
Topics: Burns; Humans; Skin; Skin Transplantation; Wound Healing
PubMed: 33499577
DOI: 10.3760/cma.j.cn501120-20191223-00468 -
Journal of Wound Care Dec 2023
Topics: Humans; Skin Transplantation; Wound Healing; Burns
PubMed: 38175772
DOI: 10.12968/jowc.2023.32.Sup12a.S14 -
Urology Sep 2020To demonstrate a technique for performing panniculectomy and skin graft for a patient with adult buried penis, highlighting a number of technical modifications that...
OBJECTIVE
To demonstrate a technique for performing panniculectomy and skin graft for a patient with adult buried penis, highlighting a number of technical modifications that allow for the procedure to be performed as an outpatient.
METHODS
Pannus is mobilized with a modified trapezoid incision, leaving superior attachments intact for skin graft harvest. Diseased penile skin is removed, defect is measured, and an appropriately sized split thickness skin graft is harvested from the pannus in 2-inch sections at a depth of 18/1000. The unmeshed graft is applied to the penis and covered with a bolster that is secured to the penis for 5-7 days. Patients are discharged postoperative day 0 or 1.
RESULTS
From 2017 to 2019, 19 patients underwent outpatient adult-buried penis repair. Median follow-up was 11.5 months. Median age was 70 years, median body mass index was 43.4, 9 (47%) patients had pathologically confirmed lichen sclerosus. Graft take was ≥95% in all patients. Complications included cellulitis (5, 26%) and minor dehiscence (3, 16%). No patients experienced deep vein thrombosis.
CONCLUSION
Outpatient panniculectomy and skin graft is an effective treatment option for patients with adult buried penis.
Topics: Abdominoplasty; Aged; Ambulatory Surgical Procedures; Cellulitis; Humans; Male; Penile Diseases; Skin Transplantation; Surgical Wound Dehiscence
PubMed: 32590082
DOI: 10.1016/j.urology.2020.04.129 -
Foot and Ankle Clinics Sep 2019There are multiple techniques to treat tendon defects in the event end-to-end repair cannot be achieved after débridement. In general, the choice of treatment technique... (Review)
Review
There are multiple techniques to treat tendon defects in the event end-to-end repair cannot be achieved after débridement. In general, the choice of treatment technique is based on size of the resultant gap. Although each treatment technique has literature to support its use, there are no data to support the use of one technique over another. Treatment should be based on the experience and discretion of the treating surgeon. This article proposes an algorithm for wound breakdown, infection, and rerupture after Achilles tendon surgery. This algorithm should be used as a guide.
Topics: Achilles Tendon; Allografts; Debridement; Humans; Negative-Pressure Wound Therapy; Postoperative Complications; Recurrence; Skin Transplantation; Tendon Injuries; Tendon Transfer
PubMed: 31370996
DOI: 10.1016/j.fcl.2019.04.008 -
Sultan Qaboos University Medical Journal Aug 2019Compartment syndrome is a surgical emergency that could be resolved by a fasciotomy. However, performing substantial skin incisions may lead to life-threatening... (Review)
Review
Compartment syndrome is a surgical emergency that could be resolved by a fasciotomy. However, performing substantial skin incisions may lead to life-threatening complications. This narrative review aimed to present the available methods of wound closure and preferential factors for using each technique. Viable and non-infected wounds were most often treated by gradual approximation techniques, such as the simple or modified shoelace technique, the prepositioned intracutaneous suture or several commercially-available mechanical devices. In addition, applying negative pressure therapy was found to be feasible, particularly when combined with approximation techniques. Skin grafting was reserved for severely-dehiscent wounds while other non-invasive approaches were considered for other subsets of patients with inadvisable surgical interventions. Treatment decision should be made in view of the patient's condition, ease of application, availability of resources, cost of treatment and aesthetic outcomes.
Topics: Compartment Syndromes; Dermatologic Surgical Procedures; Fasciotomy; Humans; Negative-Pressure Wound Therapy; Skin Transplantation; Suture Techniques; Tissue Expansion; Wound Healing
PubMed: 31728216
DOI: 10.18295/squmj.2019.19.03.004 -
American Journal of Veterinary Research Nov 2021To report the clinical outcomes of the use of acellular fish skin grafts (FSGs) for the management of complex soft tissue wounds of various etiologies in dogs and cats.
OBJECTIVE
To report the clinical outcomes of the use of acellular fish skin grafts (FSGs) for the management of complex soft tissue wounds of various etiologies in dogs and cats.
ANIMALS
13 dogs and 4 cats with complex wounds treated with FSGs between February 2019 and March 2021.
PROCEDURES
Medical records were reviewed for information regarding cause, location, size of the wound, management techniques, complications, and clinical outcomes.
RESULTS
In dogs, the number of FSG applications ranged from 1 to 4 (median, 2 graft applications). The time between each application ranged from 4 to 21 days (median, 9.5 days). Time to application of the first FSG ranged from 9 to 210 days (median, 19 days). Wounds closed by second-intention healing following the first fish skin application between 26 and 145 days (median, 71 days; n = 12). In cats, 1 or 2 FSGs were used, and the wounds of 3 of 4 cats healed completely by secondary intention. The wounds of 1 dog and 1 cat did not heal. There were no adverse events attributed to the use of the FSGs.
CLINICAL RELEVANCE
For dogs and cats of the present study, complete healing of most wounds occurred with the use of FSGs, the application of which did not require special training, instruments, or bandage materials.
Topics: Animals; Bandages; Cat Diseases; Cats; Dog Diseases; Dogs; Skin Transplantation; Wound Healing
PubMed: 34843446
DOI: 10.2460/ajvr.21.09.0140 -
Journal of Burn Care & Research :... Nov 2022Extensive burns involving the back pose unique challenges. Offloading in the prone position is not possible with concomitant deep facial and neck burns. We describe our...
Extensive burns involving the back pose unique challenges. Offloading in the prone position is not possible with concomitant deep facial and neck burns. We describe our experience in maximizing graft take in a patient who had extensive back burns with concomitant anterior body burns. The two main goals in graft fixation for extensive back wounds are mechanical stabilization of micrografts to reduce shearing and prevention of water logging from exudates or bleeding to optimize contact with wound bed. Guided by the stages of wound healing, graft take, and burn care, we describe three stages of postoperative negative pressure wound therapy (NPWT) in a patient with 54% TBSA burns treated with micrografting. After complete excision of the deep dermal burns of the entire back, the wounds were covered with micrograft-allograft composites. In phase I, days 1 to 3, conventional topical negative pressure dressing with a thin sponge was applied and a leak-proof seal was achieved with gel sealant and high tack adhesive drapes. In phase II, days 4 to 5, foam dressings with topical negative pressure were applied, but with a less stringent seal, supported by wall suction. In phase III, the selective removal of allografts was initiated to facilitate expansion of micrografts. Negative pressure was continued for another 2 weeks at the most dependent site to prevent wound maceration from exudates. Micrograft take was optimized with the patient in the supine/semirecumbent position. The back wounds healed completely between 60 and 70 days without repeat micrografting. Since prone positioning was not possible in this patient, clearance of exudates and maintenance of micrograft contact with the wound bed using this technique proved successful.
Topics: Humans; Burns; Negative-Pressure Wound Therapy; Skin Transplantation; Bandages; Wound Healing; Back Injuries
PubMed: 36053550
DOI: 10.1093/jbcr/irac130 -
Journal of Plastic, Reconstructive &... Aug 2019Allograft skin (AS) transplantation has been considered to be the gold standard for replacing tissue damage, following burns. However, increasingly new biosynthetic skin... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Allograft skin (AS) transplantation has been considered to be the gold standard for replacing tissue damage, following burns. However, increasingly new biosynthetic skin substitutes are being developed as alternatives. The objective of this systematic review is to compare AS with other skin substitutes, which have been used in the treatment of burns.
METHODS
Randomized clinical trial (RCT) and nonrandomized clinical trial (NRCT) studies comparing AS to any other skin substitute in the treatment of burns were extracted from PubMed/Medline, Scopus, EMBASE, and Web of Science. For the risk of bias analysis, the Cochrane bias risk handbook was used for RCT studies and ROBINS-1 was used for NRCT studies. Outcomes such as healing, self-grafting, scar appearance, and mortality were evaluated.
RESULTS
Twelve RCT and six NRCT were selected, with most of the methodologies presenting a high risk of bias. Based on the outcomes of the studies, it was not possible to detect any advantages for using AS, as opposed to other skin substitutes. In the meta-analysis, only two outcomes could be evaluated: healing and graft take percentage; however, no significant differences were observed between the groups.
CONCLUSION
Because of the poor quality of the primary studies, it was not possible to identify differences in the results that compared the use of AS with other substitutes in the treatment of patients with burns. These results support the fact that surgeons primarily base the choice of skin substitute on clinical experience and cost, at least when treating burns.
Topics: Burns; Cicatrix; Clinical Decision-Making; Graft Survival; Humans; Skin Transplantation; Skin, Artificial; Transplantation, Homologous; Wound Healing
PubMed: 31176542
DOI: 10.1016/j.bjps.2019.04.013 -
Biomedical Physics & Engineering Express Apr 2023Skin graft designs play an essential role in healing severe burn injuries. Split-thickness skin grafting (STSG) is one of the commonly used techniques for treating large...
Skin graft designs play an essential role in healing severe burn injuries. Split-thickness skin grafting (STSG) is one of the commonly used techniques for treating large burn injuries. In STSG, parallel cuts are projected onto a small portion of excised healthy skin for expansion and covering a larger burn area. To date, expansions reported for STSG are very low and insufficient to cover large burn areas. In this work, novel traditional and auxetic hierarchical cuts were designed on skin graft simulants, which were mechanically tested to study their expansion potential. Additive manufacturing and a two-part polymeric material were employed to fabricate the skin graft simulants. The nonlinear mechanical behavior of the hierarchical skin graft simulants was characterized using hyperelastic models. The effective Poisson's ratio, meshing ratios, and induced stresses in first and second-order hierarchical cut patterns were estimated across all skin graft simulants for up to 300% strain. Also, Statistical analysis was performed to calculate the significance among the groups. From the analysis, the skin graft simulants with second-order auxetic incision patterns were found to exhibit the lowest induced stresses and maximum expansion of approximately four times, at 300% strain. To date, traditional skin grafts have only been able to achieve up to three times expansion. Therefore, the expansions realized with the novel hierarchical skin graft simulants is unprecedented, with the potential to generate ground-breaking advances in burn injury treatment.
Topics: Humans; Skin Transplantation; Skin; Wound Healing; Burns
PubMed: 36947874
DOI: 10.1088/2057-1976/acc661