scholarly journals Skin Graft

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Ruka Shimizu ◽  
Kazuo Kishi
Keyword(s):  
Plastic Surgery ◽  
Skin Graft ◽  
Skin Grafting ◽  
Present Review ◽  
Skin Grafts ◽  
Skin Flaps ◽  
Muscle Flaps ◽  
Scar Contracture ◽  
Contracture Release ◽  
Complex Wounds

Skin graft is one of the most indispensable techniques in plastic surgery and dermatology. Skin grafts are used in a variety of clinical situations, such as traumatic wounds, defects after oncologic resection, burn reconstruction, scar contracture release, congenital skin deficiencies, hair restoration, vitiligo, and nipple-areola reconstruction. Skin grafts are generally avoided in the management of more complex wounds. Conditions with deep spaces and exposed bones normally require the use of skin flaps or muscle flaps. In the present review, we describe how to perform skin grafting successfully, and some variation of skin grafting.

Skin Grafting

2019 ◽  
pp. 65-72
Author(s):  
Stephen M. Milner
Keyword(s):  
Skin Grafting ◽  
Skin Grafts ◽  
Full Thickness ◽  
Preoperative Preparation ◽  
Scar Contracture ◽  
Skin Defects ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Contracture Release

Skin grafting is an indispensable technique used in a variety of clinical situations, including acute burns, traumatic wounds, scar contracture release, and oncological and congenital deficiencies. The author’s preferred techniques for harvesting and resurfacing various skin defects using split- and full-thickness skin grafts are described in this chapter, together with the assessment of donor and recipient sites, preoperative preparation and postoperative considerations.

Use of Mechanical Stretching to Treat Skin Graft Contracture

2020 ◽  
Vol 41 (4) ◽  
pp. 892-899
Author(s):  
Jinfeng Zhou ◽  
Youcai Zhao ◽  
Wengbo Yang ◽  
Qianming Du ◽  
Jun Yin ◽  
...  
Keyword(s):  
Skin Graft ◽  
Smooth Muscle Actin ◽  
Picric Acid ◽  
Skin Grafting ◽  
Control Group ◽  
Skin Grafts ◽  
Alpha Smooth Muscle Actin ◽  
Treatment Measures ◽  
And Function ◽  
Mechanical Stretching

Abstract After transplantation, skin grafts contract to different degrees, thus affecting the appearance and function of the skin graft sites. The exact mechanism of contracture after skin grafting remains unclear, and reliable treatment measures are lacking; therefore, new treatment methods must be identified. Many types of centripetal contraction forces affect skin graft operation, thus leading to centripetal contracture. Therefore, antagonizing the centripetal contraction of skin grafts may be a feasible method to intervene in skin contracture. Here, the authors propose the first reported mechanical stretching method to address contracture after skin grafting. A full-thickness skin graft model was established on the backs of SD rats. The skin in the experimental group was stretched unilaterally or bidirectionally with a self-made elastic stretching device, whereas the skin was non-stretched in the control group. The rats were sacrificed 2 weeks after stretching. The area, length, and width of the skin were measured. The grafts were cut and fixed with formalin. Routine paraffin sections were stained with hematoxylin-eosin, picric acid-Sirius red, Victoria blue, and anti-alpha-smooth muscle actin (SMA). Mechanical stretching made the graft lengthen in the direction of the stress and had an important influence on collagen deposition and alpha-SMA expression in the graft. This method warrants further in-depth study to provide a basis for clinical application.

scholarly journals The Technique of Free Skin Grafting in Mammals

1951 ◽  
Vol 28 (3) ◽  
pp. 385-402 ◽  
Author(s):  
R. E. BILLINGHAM ◽  
P. B. MEDAWAR
Keyword(s):  
Plastic Surgery ◽  
Guinea Pigs ◽  
Skin Grafting ◽  
Skin Grafts ◽  
University Of Oxford

Methods are described for the execution of free skin grafts in rabbits, guinea-pigs and mice. Much of the work in which use has been made of the techniques described above has been generously supported over a period of years by the Department of Plastic Surgery, University of Oxford (Prof. T. Pomfret Kilner, F.R.C.S.).

643 The Use of Topical Exogenous Nutrient Supplementation to Improve Graft Take on an Avascular Wound Bed

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S167-S168
Author(s):  
Laura Cooper ◽  
Phillip Kemp Bohan ◽  
Anders H Carlsson ◽  
Rodney K Chan ◽  
Tyler Everett
Keyword(s):  
Graft Survival ◽  
Skin Graft ◽  
Skin Grafting ◽  
Dermal Substitute ◽  
Skin Grafts ◽  
Pressure Therapy ◽  
Nutrient Supplementation ◽  
Successful Model ◽  
Dermal Substitutes ◽  
Graft Take

Abstract Introduction Skin graft survival relies on imbibition, inosculation, and revascularization from the wound bed. When a wound bed is poorly vascularized, as in the case of exposed fascia, tendon or bone, skin grafting may be delayed until the wound bed improves. We propose that topical nutrient supplementation may be able to increase take of skin grafts applied over an avascular wound bed. Methods Twenty full-thickness 5cm-diameter wounds were created on the dorsum of anesthetized swine and a dermal substitute (0.4mm, 0.8mm, 1.2mm, or 1.6mm thick) was placed on each wound. Negative pressure therapy with and without intermittent (3x per day) saline instillation was applied. Wounds were analyzed using a non-contact 3D camera at day 7 and day 14. Results Dermal substitutes of 0.8mm, 1.2mm, and 1.6mm thicknesses inhibited graft take significantly (p< 0.01, p=0.02, p< 0.01, respectively) for all wounds treated with wound vac alone. Addition of the normal saline instill showed a significant improvement in graft take (p=0.03) over wound vac alone for the wounds treated with the 0.8mm dermal substitute. Wounds covered with 1.2mm and 1.6mm dermal substitute continued to show significantly decreased graft take (p=0.03 and p=0.02, respectively). Wounds with 0.4mm dermal substitute showed similar graft take to control for both the wound vac and wound vac + instill treatments. Conclusions Dermal substitutes ≥0.8mm create a successful model of an avascular wound bed. Vac + instill treatment overcame the impedance of an avascular wound bed only for the 0.8mm dermal substitute thickness. This thickness of dermal substitute creates an ideal avascular wound bed model from which to conduct further studies incorporating topical nutrients instilled directly onto skin grafts placed onto avascular wound beds. Applicability of Research to Practice Single-stage skin grafting procedures onto avascular wound beds may become feasible with topical nutrient supplementation providing the environment to maintain graft survival until the wound bed is able to support the skin graft.

scholarly journals Serial Excision for the Treatment of Giant Congenital Melanocytic Nevus: The Vietnamese Way

2019 ◽  
Vol 7 (2) ◽  
pp. 231-233
Author(s):  
Son Nguyen Hong ◽  
Nghi Dinh Huu ◽  
Nham Nguyen Duy ◽  
Tuy Than Trong ◽  
Hung Nguyen Bac ◽  
...  
Keyword(s):  
Plastic Surgery ◽  
Tissue Expansion ◽  
Skin Grafting ◽  
Melanocytic Nevus ◽  
Skin Closure ◽  
Congenital Melanocytic Nevus ◽  
Skin Grafts ◽  
Good Outcome ◽  
Serial Excision ◽  
Giant Congenital Melanocytic Nevus

AIM: To investigate the efficacy of plastic surgery in the treatment of giant congenital melanocytic nevus (GCMN). METHODS:  We enrolled 20 patients with 44 lesions and performed one of the following procedures: serial excision, skin grafting, tissue expansion, primary skin closure, distant flap, and adjacent flap. We assessed the outcome at 10 days and 6 months after surgery. RESULTS: Of 44 surgical sites, the most commonly used reconstruction surgeries were serial excision (16), skin grafting (16), and tissue expansion (6). Other types were rarely used. All patients with serial excision had good outcome. A total of 81% and 19% of the patients with skin grafting had good and fair outcome, respectively. Around 83% and 17% of the patients with tissue expansion had good and fair outcome. No cases had bad outcome. CONCLUSION: In conclusion plastic surgery is effective in the treatment of GCMN. There are different techniques but serial excision, skin grafts, and tissue expansion are most commonly used.

scholarly journals Congenital Syndactyly of the Fingers : A Report of Two Cases

2016 ◽  
Vol 06 (01) ◽  
pp. 082-084
Author(s):  
Sanath Kumar Shetty ◽  
Anoop Hegde ◽  
Lawrence John Mathias ◽  
H. Ravindranath Rai
Keyword(s):  
Full Range ◽  
Skin Grafting ◽  
Middle Finger ◽  
Interesting Case ◽  
Range Of Movement ◽  
Scar Contracture ◽  
Left Hand ◽  
Thickness Skin ◽  
Percutaneous Release ◽  
Contracture Release

AbstractSyndactyly is defined as the failure of separation of the digits during early gestation. It is one of the most common congenital anomalies. The incidence of syndactyly is uncertain, but estimates range from 1 in 2,500 live births. During development, the fingers are webbed. This remains so, until apoptosis and skin recession allow for formation of the digital interspaces. Full inter-digital spaces are usually present by the end of the 6th week of gestation.Here we present two patients and three hands who presented to us with syndactyly of the fingers. The first patient who was a 13 year old girl, had complete complex syndactyly between the ring and middle fingers of both hands. She underwent complete release with full thickness skin grafting in the first sitting. Six weeks later, she was reviewed and was noted to have developed scar contracture of the middle finger for which she underwent contracture release and z-plasty as a secondary procedure. In the final review at four months after the second surgery, the child was noted to have only terminal restriction of movements of the involved fingers of both hands with 'fair results' (as per the criteria of Cortez et al).The second patient was a two years old boy, who presented to us with incomplete simple syndactyly of the ring and index finger of the left hand. He was managed with percutaneous release of the syndactyly. He was reviewed after 4 months and there was full range of movement of the involved digits. He was also noted to have 'fair results' (as per the criteria of Cortez et al).As we had two different cases with a heterogenous presentation of two different types of syndactyly and who underwent different modalities of management, we are presenting it as an interesting case report in our article.

scholarly journals Negative Pressure Dressings over Free Muscle Flaps with Immediate Split-Thickness Skin Grafting: A 9-Year Experience

2020 ◽  
Vol 05 (01) ◽  
pp. e27-e31
Author(s):  
Pallavi A. Kumbla ◽  
Steven L. Henry ◽  
Carter J. Boyd ◽  
Patrick K. Kelley ◽  
Ashley Q. Thorburn ◽  
...  
Keyword(s):  
Skin Graft ◽  
Negative Pressure ◽  
Skin Grafting ◽  
Flap Necrosis ◽  
Muscle Flaps ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Muscle Necrosis ◽  
Negative Pressure Dressings ◽  
Pressure Dressing

Abstract Background Negative pressure wound therapy has allowed for significant advances in the treatment of wounds. This occurs through a process of angiogenesis, microdeformation, macrodeformation, and decrease in exudate and bacterial load. It is routinely used as a bolster in the management of skin grafts. However, its role as a dressing over free muscle flaps has not gained widespread acceptance due to the fear of flap compromise. Methods A retrospective review of 97 patients over 9 years was performed. All patients underwent free muscle flap coverage of various wounds with immediate split-thickness skin grafting. A negative pressure dressing was applied, with windows made in the foam sponge to enable Doppler monitoring as well as visual inspection of the flap. Complications including flap failure, skin graft loss, hematoma, distal flap necrosis, negative pressure dressing failure, partial muscle necrosis, and mild flap congestion were assessed. Results Flap loss occurred at a rate of 8.2% (eight flaps). Four of these flaps were lost due to patient factors not attributable to the dressing. In the remaining four flaps (4.1% of the series), it is conceivable that the negative pressure dressing was a contributing factor. However, this failure rate is comparable to flap loss rates in studies where negative pressure dressings were not used. The rates of skin graft failure, hematoma, distal flap necrosis, inability to maintain seal, partial muscle necrosis, and mild flap congestion were also acceptable and similar to studies where negative pressure dressings were not used. Conclusion Negative pressure dressings over free muscle flaps with immediate split-thickness skin grafts are effective and safe to use while allowing for postoperative flap monitoring and skin graft protection.

scholarly journals Usefulness of Local Flaps for Scar Contracture Release

2020 ◽  
pp. 301-309
Author(s):  
Rei Ogawa
Keyword(s):  
Pedicled Flap ◽  
Local Flap ◽  
Skin Grafts ◽  
Local Flaps ◽  
Healthy Skin ◽  
Pedicled Flaps ◽  
Scar Contracture ◽  
First Choice ◽  
Contracture Release ◽  
Texture Match

AbstractLocal flaps are useful for reconstructing scar contractures on mobile areas such as joints, the neck, the axilla, the digital web, and the mouth commissure. They are superior to skin grafts because the latter can contract, thereby leading to secondary contractures. Moreover, the color and texture match of local flaps is better than that of grafted skin. Consequently, local flaps generally provide superior aesthetic outcomes. Thus, if there is healthy skin adjacent to the scar contracture, local flaps should be the first choice. In terms of local flap selection, it is necessary to choose between a skin-pedicled flap and an island flap. We showed recently that 6 months after surgery, skin-pedicled flaps associate with greater scar extension rates than island flaps. Thus, local flaps, especially skin-pedicled flaps, elongate the scar as effectively as z-plasty. It should be noted that if the scar is large, it is effective only by dividing the scar with the local flap. However, the flap size can be slightly smaller than the deformity size (although how much smaller depends somewhat on how extensible the flap type is): it is not necessary that the flap is as big as the open wound after scar division or scar removal.

scholarly journals Notch-Expanded Murine Hematopoietic Progenitor Cells Can Induce Immune Tolerance in Mismatched Recipients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2430-2430
Author(s):  
Fabiola V Merriam ◽  
Ian Nicoud ◽  
Filippo Milano ◽  
Jianqiang Li ◽  
Shelly Heimfeld ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Progenitor Cells ◽  
Skin Graft ◽  
Immune Tolerance ◽  
Skin Grafting ◽  
Lymphoid Cells ◽  
Solid Organ ◽  
Skin Grafts ◽  
Notch Ligand ◽  
Donor Chimerism

Abstract Introduction: Our lab has developed novel methods, using an engineered form of the Notch ligand Delta-1, for the ex vivo expansion of cord blood CD34+ hematopoietic stem and progenitor cells (HSPC) for clinical applications. These same methods can be used to expand primary murine HSPC. We have previously demonstrated that transplantation of completely mismatched Notch-expanded lin-/sca-1+/c-kit+ (LSK) cells can prolong survival in mice that received lethal total body irradiation (TBI). The mismatched LSK cells rapidly reconstitute myeloid cells in irradiated recipients that are short-lived, with low-level persistence of lymphoid cells (CD4/CD8) for more than 90 days. This long-term chimerism was directly proportional to the TBI dose, with higher levels of persistent donor engraftment with increasing TBI. We hypothesized that the residual donor lymphoid cells were de novo generated, tolerant by virtue of host education, and might convey immune tolerance. Herein, we now demonstrate the ability of engrafted mismatched Notch-expanded LSK cells to induce immune tolerance toward the same mismatched donor using a skin allograft technique. Methods: Bone marrow LSK cells from Ly5a mice (H-2b, CD45.1) were cultured for 14 days in the presence of engineered Notch ligand, Delta1ext-IgG. The progeny were harvested and cryopreserved and later transplanted into Balb/c (H-2d, CD45.2) mice that were lethally irradiated with 7.5 Gy at a dose of 5x106 cells per mouse. Control animals received 2x105 fresh Balb/c bone marrow cells. 60 days post-transplant, reconstitution and donor chimerism was assessed in the peripheral blood of the recipient mice and bilateral allogeneic and autologous skin grafting was performed. Chimerism ranged from 0 to 12%, with a mean of 3%. Mice were evenly distributed by chimerism into the following 3 groups: mice receiving autologous Balb/c skin graft on the left flank and either a mismatched Ly5a or third-party C3H (H-2k, CD45.2) skin graft on the right flank, or the combination of Ly5a and C3H. Seven days after skin grafting, the dressings were removed and the grafts were scored daily for a period of 30 days. The day of rejection was defined as > 80% of the graft being necrotic, scabbed, or dislodged from the graft bed. Results: Control animals (those reconstituted with Balb/c marrow, Figure 1A, dashed line) had 0% rejection of Balb/c grafts (0/5) and 100% rejection of C3H grafts (6/6) and Ly5a skin grafts (7/7) within the first 10 days. Experimental animals (those reconstituted with expanded Ly5a cells, Figure 1A, solid line) also had 0% rejection of Balb/c skin grafts (0/12). As with Control animals, chimeric mice also had 100% rejection of the C3H grafts (10/10) within the first 10 days after implantation. Interestingly, chimeric animals that received Ly5a skin grafts showed a slower rate of rejection over a period of 30 days; by day 10 only 45.5% had rejected (5/11), another 45.5% rejected between day 10 and 21 (5/11) and 9% (1/11) had complete engraftment of the Ly5a skin without any signs of rejection to present day. Figure 1B shows complete engraftment of Ly5a skin on Balb/c mice that received expanded Ly5a cells. The black arrow shows a contracted scar of the C3H graft rejection and blue arrow shows tolerance to the Ly5a. T test of the graft survival times between mice receiving Balb/c marrow and expanded Ly5a LSK that received Ly5a skin grafts was significant (p=0.05) as was the comparison between Ly5a skin and C3H skin in animals that received expanded Ly5a LSK (p=0.05). Of note, the one animal with no rejection of Ly5a skin had the highest hematopoietic donor chimerism within that group at the time of skin grafting. Conclusion: Preliminary data from these experiments provide strong evidence that Delta1ext-IgG-expanded Ly5a LSK cells, in addition to improving hematopoietic reconstitution, are immunomodulatory and can convey immune tolerance. The results suggest that the level of donor chimerism may correlate with the degree of induced tolerance. Further experiments are being conducted with higher doses of TBI, which we have demonstrated previously result in higher persistent donor chimerism of the expanded Ly5a cells, to investigate the relationship between level of donor engraftment and immune tolerance. The ability to induce immune tolerance could be very important for solid organ transplantation, by enabling the discontinuation of antirejection medicines in transplant recipients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Outcomes of split vs full-thickness skin grafts in scalp reconstruction in outpatient local anaesthetic theatre

2021 ◽  
Vol 7 ◽  
pp. 205951312110565
Author(s):  
Luxi Sun ◽  
Animesh JK Patel
Keyword(s):  
Skin Graft ◽  
Local Anaesthetic ◽  
Skin Grafting ◽  
Skin Grafts ◽  
Full Thickness ◽  
Full Thickness Skin ◽  
Graft Take ◽  
Thickness Skin ◽  
Graft Reconstruction ◽  
Scalp Skin

Background Surgical excision remains the cornerstone of simultaneous diagnosis and treatment of suspicious skin lesions, and the scalp is a high-risk area for skin cancers due to increased cumulative lifetime ultraviolet (UV) exposure. Due to the inelasticity of scalp skin, most excisions with predetermined margins require reconstruction with skin grafting. Methods A retrospective single-centre cohort study was performed of all patients undergoing outpatient local anaesthetic scalp skin excision and skin graft reconstruction in the Plastic Surgery Department at Addenbrookes Hospital over a 20-month period between 1 April 2017 and 1 January 2019. In total, 204 graft cases were collected. Graft reconstruction techniques included both full-thickness and split-thickness skin grafts. Statistical analysis using Z tests were used to determine which skin grafting technique achieved better graft take. Results Split-thickness skin grafts had a statistically significant ( P = 0.01) increased average take (90%) compared to full-thickness skin grafts (72%). Using a foam tie-over dressing on the scalp led to a statistically significant ( P = 0.000036) increase in skin graft take, from 38% to 79%. Conclusion In skin graft reconstruction of scalp defects after skin cancer excision surgery, split skin grafts secured with foam tie-over dressings are associated with superior outcomes compared to full-thickness skin grafts or grafts secured with sutures only.

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