Large defects in aplasia cutis congenita treated by large-sized thin split-thickness skin grafting: long-term follow-up of 18 patients

2015 ◽  
Vol 54 (6) ◽  
pp. 710-714 ◽  
Author(s):  
Yan Liu ◽  
Lin Qiu ◽  
Yuexian Fu ◽  
Xiaofei Tian ◽  
Xingang Yuan ◽  
...  
Hernia ◽  
2021 ◽  
Author(s):  
V. Holmdahl ◽  
B. Stark ◽  
L. Clay ◽  
U. Gunnarsson ◽  
K. Strigård

Abstract Purpose Conventional repair of a giant incisional hernia often requires implantation of a synthetic mesh (SM). However, this surgical procedure can lead to discomfort, pain, and potentially serious complications. Full-thickness skin grafting (FTSG) could offer an alternative to SM, less prone to complications related to implantation of a foreign body in the abdominal wall. The aim of this study was to compare the use of FTSG to conventional SM in the repair of giant incisional hernia. Methods Patients with a giant incisional hernia (> 10 cm width) were randomised to repair with either FTSG or SM. 3-month and 1-year follow-ups have already been reported. A clinical follow-up was performed 3 years after repair, assessing potential complications and recurrence. SF-36, EQ-5D and VHPQ questionnaires were answered at 3 years and an average of 9 years (long-term follow-up) after surgery to assess the impact of the intervention on quality-of-life (QoL). Results Fifty-two patients were included. Five recurrences in the FTSG group and three in the SM group were noted at the clinical follow-up 3 years after surgery, but the difference was not significant (p = 0.313). No new procedure-related complication had occurred since the one-year follow-up. There were no relevant differences in QoL between the groups. However, there were significant improvemnts in both physical, emotional, and mental domains of the SF-36 questionnaire in both groups. Conclusion The results of this long-term follow-up together with the results from previous follow-ups indicate that autologous FTSG as reinforcement in giant incisional hernia repair is an alternative to conventional repair with SM. Trial Registration The study was registered August 10, 2011 at ClinicalTrials.gov (ID NCT01413412), retrospectively registered.


2020 ◽  
Vol 59 (3) ◽  
pp. 498-501
Author(s):  
Elliot T. Walters ◽  
Mira Pandya ◽  
Neha Rajpal ◽  
Michel M. Abboud ◽  
Tammer Elmarsafi ◽  
...  

2018 ◽  
Vol 84 (11) ◽  
pp. 1790-1795 ◽  
Author(s):  
Margaret H. Lauerman ◽  
Thomas M. Scalea ◽  
W. Andrew Eglseder ◽  
Raymond Pensy ◽  
Deborah M. Stein ◽  
...  

Little data exist about management of wounds created by debridement in necrotizing soft tissue infections (NSTIs). Multiple wound coverage techniques exist, including complete primary wound closure, split-thickness skin grafting, secondary intention, and flap creation. We hypothesized that all wound coverage techniques would be associated with high rates of successful wound coverage and low crossover rates to other wound coverage techniques. NSTIs over a three-year period were retrospectively reviewed. Both the initial and secondary wound coverage techniques (if necessary) were recorded. The primary outcome was the ability to achieve complete wound coverage. Overall, 46 patients with NSTIs had long-term data available. Of the patients undergoing split-thickness skin grafting as the initial wound coverage technique, 8/8 (100%) achieved complete wound coverage; and of those undergoing flap creation, 1/1 (100%) achieved complete wound coverage; and of those undergoing complete primary wound closure, 4/4 (100%) achieved complete wound coverage. Of the patients undergoing secondary intention as the initial wound coverage technique, 5/33 (15.2%) achieved complete wound coverage and 28/33 (84.8%) required a secondary wound coverage technique with split-thickness skin grafting. All 46 patients achieved long-term successful wound coverage. Time to wound coverage did not vary with initial wound coverage technique ( P = 0.44). Split-thickness skin grafting, flap creation, complete primary wound closure, and secondary intention are all reasonable choices for initial wound coverage for NSTIs. Although secondary intention had a low success rate as an initial wound coverage technique, all patients ultimately achieved complete wound coverage without a significant increase in time to coverage.


2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Jenna C. Bekeny ◽  
Christopher Kennedy ◽  
Jon D. Turissini ◽  
Iram Naz ◽  
Elliot T. Walters ◽  
...  

Objective Porcine-derived xenograft biological dressings (PXBDs) are occasionally used to prepare chronic wound beds for definitive closure before split-thickness skin grafts (STSGs). We sought to determine whether PXBD influences rate of STSG take in lower-extremity wounds. Methods Lower-extremity wounds treated with STSGs were retrospectively reviewed. Patients were included in one of two groups: wound bed preparation with PXBD before STSG or no preparation. Patients were excluded if they received wound bed preparation via another method. Patient demographics, comorbidities, wound history, wound bed preparation, and 30- and 60-day outcomes were collected. Results There was no difference in healing outcomes between the PXBD (n = 27) and no preparation (n = 39) groups. At 30- and 60-day follow-up, percentage of STSG take was not significantly different between groups (77.9% versus 79.0%, P30 = .818; 82.2% versus 80.9%, P60 = .422). Mean wound sizes at these follow-up periods were not different (4.4 cm2 versus 5.1 cm2, P30 = .902; 1.2 cm2 versus 1.1 cm2, P60 = .689). The PXBD group had a higher mean ± SD hemoglobin A1c level (8.3 ± 3.5 versus 6.9 ± 1.6; P = .074) and age (64.9 ± 12.8 years versus 56.3 ± 11.9 years; P = .007) versus the no preparation group. Conclusions Application of PXBDs for wound bed preparation had no effect on wound healing compared with no wound bed preparation. The two groups varied only by mean age and hemoglobin A1c level. The PXBD may be beneficial, but these results call for randomized controlled trials to determine the true impact of PXBDs on wound healing. In addition, PXBDs may have utility outside of clinically oriented outcomes, and future work should address patient-reported outcomes and pain scores with this adjunct.


Open Medicine ◽  
2010 ◽  
Vol 5 (6) ◽  
pp. 674-678 ◽  
Author(s):  
Birol Civelek ◽  
Kadir Aksoy ◽  
Esra Bilgen ◽  
Ibrahim İnal ◽  
Unal. Sahin ◽  
...  

AbstractHidradenitis suppurativa is a chronic, debilitating inflammatory disease of apocrine glands characterized with abscesses and nodular lesions. The treatment of Hidradenitis suppurativa consists of topical antibacterial or antiseptic solutions, systemic antibiotics, steroids, hormonal therapy, anti-tumor necrosis factor, and various surgical procedures. In this report, we present a series of 14 cases with severe Hidradenitis suppurativa. Surgical options are reviewed to show the best outcomes in the long term. A total of 14 patients (9 female, 5 male) were treated for advanced cases of Hidradenitis suppurativa. They underwent excision of the affected regions followed by reconstruction. The reconstruction methods consisted of split-thickness skin grafting and various cutaneous and myocutaneous flaps. There was no flap necrosis or dehiscence. One patient developed contracture in the axilla, for which he underwent release surgery. There were recurrences in 4 cases. There was no limitation of the arm movements in cases with flap reconstruction. In the long-term, they were satisfied with the results. In conclusion, incision and drainage should be avoided because it is of limited value. Surgical removal of the involved tissue should be the first treatment of choice. Depending on the defect following excision, local flaps should be preferred over the grafts for recurrence prevention.


2016 ◽  
Vol 98 (7) ◽  
pp. e111-e113 ◽  
Author(s):  
B Martin ◽  
L Treharne

A term neonate was born with a grossly swollen and discoloured left hand and forearm. He was transferred from the local hospital to the plastic surgical unit, where a diagnosis of compartment syndrome was made and he underwent emergency forearm fasciotomies at six hours of age. Following serial debridements of necrotic tissue, he underwent split-thickness skin grafting of the resultant defects of his forearm, hand and digits. At the clinic follow-up appointment two months after the procedure, he was found to have developed severe flexion contractures despite regular outpatient hand therapy and splintage. He has had further reconstruction with contracture release, use of artificial dermal matrix, and K-wire fixation of the thumb and wrist. Despite this, the long term outcome is likely to be an arm with poor function. The key learning point from this case is that despite prompt transfer, diagnosis and appropriate surgical management, the outcome for neonatal compartment syndrome may still be poor.


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