scholarly journals Intraoperative tissue expansion as an alternative approach for hand syndactyly management to avoid skin grafts in children

2018 ◽  
Vol 75 (3) ◽  
pp. 290-296
Author(s):  
Djordje Kravljanac ◽  
Radoje Simic ◽  
Ivan Milovic
Keyword(s):  
Tissue Expansion ◽  
Skin Grafting ◽  
Functional Results ◽  
Skin Grafts ◽  
Local Flaps ◽  
Associated Anomalies ◽  
Dorsal Hand ◽  
Alternative Approach ◽  
Aesthetic Results

Background/Aim. A great number of syndactyly release techniques have been described over last two centuries. The aim of our study is outcome assessment of congenital syndactyly surgery using temporary tissue expansion of the dorsal hand and local flaps, without skin grafts. Methods. This study included children with congenital hand syndactyly treated in period from 2009?2015 by operative technique with temporary tissue expansion of the dorsal hand skin and local flaps, without skin grafting. In all cases surgery was performed under general anesthesia. According to Weber?s descriptive method, the functional outcome at the end of the follow-up period was categorized as good, fair or bad. All patients were evaluated for associated anomalies. Results. A total of 26 children (20 males, 6 females), aged from 6 months to 6 years (average age of 23 months), were operated by previously described technique. There were 20 patients with complete syndactyly and 6 with incomplete, mostly involving the third web. Associated anomalies were diagnosed in 9 patients. The follow-up period ranged from 1 to 5 years with average duration of 2.6 years. The functional results were good in 20 patients, fair in 5 and bad in 1 patient. Conclusion. Surgical procedure with temporary tissue expansion of the dorsal hand skin and local flaps, without skin grafting is effective method of congenital syndactyly treatment in children with good functional and aesthetic results. The advantages of this technique are the reduction of surgery duration and avoiding certain complications, such as web hair growth, hyperpigmentation and hypertrophic scars.

scholarly journals A cross-sectional study of long-term satisfaction after surgery for congenital syndactyly: does skin grafting influence satisfaction?

2018 ◽  
Vol 44 (3) ◽  
pp. 296-303 ◽  
Author(s):  
Bien R. Ferrari ◽  
Paul M.N. Werker
Keyword(s):  
Donor Site ◽  
Skin Grafting ◽  
Cross Sectional Study ◽  
Complication Rates ◽  
Skin Grafts ◽  
Sectional Study ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Scar Assessment

Syndactyly correction without skin grafting is advocated because it prevents graft-related complications and donor site morbidity. In this cross-sectional study, we compared satisfaction among patients who underwent correction with and without skin grafting to determine preference based on subjective and objective parameters. Retrospective chart analysis was performed among 27 patients (49 webs) who were seen at follow-up after a median follow-up period of 7.4 years, at which the Patient and Observer Scar Assessment Scale, the Withey score and a satisfaction survey were used. Notably, there were no significant differences in complication rates or observer rated scar scores. Although the need for an additional surgical procedure was higher after skin grafting, patient-rated satisfaction scores were similar irrespective of the use of grafting. Our data suggest that corrections can best be performed without skin grafts if seeking to minimize the need for an additional procedure, but that the use of skin grafts does not appear to affect patient satisfaction. Level of evidence: IV

CORRECTIVE SURGERY OF SYNDACTYLY WITHOUT THE USE OF SKIN GRAFTS

Hand Surgery ◽  
1996 ◽  
Vol 01 (02) ◽  
pp. 203-209 ◽  
Author(s):  
D. Vickers ◽  
W. Donnelly
Keyword(s):  
Operative Technique ◽  
Skin Grafting ◽  
Skin Grafts ◽  
Corrective Surgery ◽  
Simple Complex ◽  
Good Outcome

This paper presents an operative technique of syndactyly release (syndactylysis) without skin grafting. A series of 31 cases, of simple, complex and complicated syndactylies are presented with a mean follow-up of 4.4 years. The results demonstrate that a good outcome can be reliably obtained by syndactylysis without the use of skin grafts.

scholarly journals Clinical pilot study to evaluate the neovaginal PACIENA prosthesis® for vaginoplasty without skin grafts in women with vaginal agenesis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Pedro Acién ◽  
Francisco J. Nohales-Alfonso ◽  
Maria-Luisa Sánchez-Ferrer ◽  
Miguel Sánchez-Lozano ◽  
Victoria Navarro-Lillo ◽  
...  
Keyword(s):  
Clinical Investigation ◽  
Bacterial Colonization ◽  
Surgical Techniques ◽  
Functional Results ◽  
University Hospital ◽  
Skin Grafts ◽  
University Hospitals ◽  
Health Products ◽  
Pilot Investigation

Abstract Background To evaluate the feasibility and clinical outcomes of vaginoplasties using a neovaginal polylactic acid prosthesis made with 3-dimensional (3D) printing technology as an intraneovaginal mould. Methods This was an interventionist, prospective, and multicentre clinical pilot investigation of a sanitary product (PACIENA prosthesis®) aiming to recruit and operate on 8 patients over 6 months with a follow-up period of 6 months. Only six patients with Rokitansky syndrome and one patient with Morris syndrome (7 patients in total) were operated on in two university hospitals: “La Fe”, Valencia (H1) and “Arrixaca”, Murcia (H2). Interventions: Extensive surgical dissection of a defined space between the urethra and bladder in the front and of the rectum in the back as well as insertion of the PACIENA prosthesis® covered with Interceed® were performed. After 12 days, the prosthesis was changed to the silicone-covered version for daily application. Results In the 6 patients with Rokitansky syndrome (86%), the primary endpoint (satisfactory vaginal outcome in terms of appearance, function, and sensation without relevant additional morbidity) was achieved, although only 2 patients (28%) were sexually active at the end of 6 months of follow-up. The patient with Morris syndrome withdrew from the study after 1 month. Patients without bacterial colonization showed positive Schiller tests at 1 month, and subsequent biopsies showed adequate keratinization and epidermization. Epithelization and iodopositivity were delayed in the patients who developed inflammatory granulomas. Conclusions Good anatomical and functional results can be achieved with the PACIENA prosthesis® for vaginoplasties without skin grafts. However, adequate patient selection and education, good surgical techniques and haemostasis, postoperative support, and prevention of bacterial colonization are important. Trial registration This clinical study was approved by the Ethical Clinical Investigation Committee of San Juan University Hospital on September 27, 2016, to be conducted in the participating centres; it was authorized by the Spanish Agency of Medicines and Health Products (AEMPS) on April 24, 2017 (exp. no. 585/16/EC), to be carried out in that hospitals.

scholarly journals MTA Cvek Pulpotomy Followed by Fragment Re-Attachment in Traumatized Young Permanent Maxillary Left Central Incisor – A Case Report

2021 ◽  
Vol 30 (1) ◽  
pp. 70-73
Author(s):  
Abul Khair Zalan ◽  
◽  
Khadeejah Khalil Zubairy ◽  
Hira Zaman ◽  
Anser Maxood ◽  
...  
Keyword(s):  
Case Report ◽  
Dental Trauma ◽  
Functional Results ◽  
Clinical Results ◽  
Central Incisor ◽  
Anterior Teeth ◽  
Alternative Approach ◽  
Long Term Follow Up ◽  
Dent Assoc

Most common form of dental trauma in children are the fractures of crown mainly in anterior teeth. A case of complicated crown fracture treated with Cvek pulpotomy using MTA followed by fragment re-attachment with careful follow-up is presented here. Tooth fragment re-attachment provides feasible conservative alternative approach to restore esthetics and tooth function. Successful outcomes have been shown by the long term follow up of the treatment with the preservation of pulp vitality and continued development of root. Clinical results have also shown good esthetics and functional results of presented technique. KEYWORDS: Complicated crown fracture, Cvek pulpotomy, MTA, fragment re-attachment HOW TO CITE: Zalan AK, Zubairy KK, Zaman H, Maxood A, Gul A, Anser M. MTA cvek pulpotomy followed by fragment re-attachment in traumatized young permanent maxillary left central incisor – A case report. J Pak Dent Assoc 2021;30(1):70-73.

Extra-wound fixation: a modified tie-over dressing technique for skin graft

2020 ◽  
Vol 29 (Sup12) ◽  
pp. S23-S27
Author(s):  
Quanmeng Liu ◽  
Xiaodong Liu ◽  
Idy HT Ho ◽  
Shibing Guan
Keyword(s):  
Clinical Outcomes ◽  
Normal Skin ◽  
Skin Grafting ◽  
Cross Sectional Study ◽  
Skin Grafts ◽  
Fixation Technique ◽  
Dressing Method ◽  
Chi Square ◽  
Cross Sectional

Objective: Tie-over dressing is the most frequently used technique of skin grafting. However, many deficiencies affecting the outcome have been reported. We hereby introduce a modified method, termed the ‘extra-wound fixation technique’, for skin dressing, and evaluate the complications and clinical outcomes. Method: In this retrospective cross-sectional study we analysed the medical records of patients treated between January 2012 and December 2017. All patients received full thickness skin grafts. Patients were divided equally into to groups: patients were treated using the extra-wound fixation technique, and the remaining, randomly selected patients treated using the traditional tie-over method. The extra-wound fixation technique uses the traditional tie-over dressing method followed by additional stitches made in healthy skin locating 0.5-1.0 cm laterally to the wound edge. The follow-up outcomes between the two groups were compared using the Chi-square test. Results: A total of 38 patients took part (19 patients in each group). The follow-up duration was 1–6 months. No raised edges were observed in any of the patients. Prolonged follow-up demonstrated that the grafted skin texture became soft with a thin layer of adipose tissue, and elasticity was gradually improved along with the regeneration of dermoelastic fibre. The colour was similar to the normal skin with a smooth surface. Compared with the traditional method, the extra-wound fixation technique significantly improved the survival of the grafted skin (p=0.008), reduced the risk of laceration of the skin (p=0.001), and eliminated crater rim-like appearances (p=0.020). Conclusion: The extra-wound fixation technique could be used for different skin grafts and improve clinical outcomes compared with the traditional tie-over dressing method.

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 Subcutaneous pedicle propeller flap: An old technique revisited and modified!

2016 ◽  
Vol 49 (02) ◽  
pp. 220-224
Author(s):  
Durga Karki ◽  
Nikhil Mehta ◽  
Ravi Prakash Narayan
Keyword(s):  
Tertiary Care ◽  
Functional Results ◽  
Care Hospital ◽  
Band Formation ◽  
Scar Contracture ◽  
Propeller Flap ◽  
Wide Range ◽  
Aesthetic Results

ABSTRACTBackground: Post-burn axillary and elbow scar contracture is a challenging problem to the reconstructive surgeon owing to the wide range of abduction and extension that should be achieved, respectively, while treating either of the joint. The aim of this paper is to highlight the use of subcutaneous pedicle propeller flap for the management of post-burn axillary and elbow contractures. Methodology: This is a prospective case study of axillary and elbow contractures managed at a tertiary care hospital using propeller flap based on subcutaneous pedicle from 2009 to 2014. Surgical treatment comprised of subcutaneous-based pedicle propeller flap from the normal tissue within the contracture based on central axis pedicle. The flap was rotated axially to break the contracture. The technique further encompassed a modification, a Zig-Zag incision of the flap, which was seen to prevent hypertrophy along the incision line. There was a mean period of 12 months of follow-up. Results: Thirty-eight patients consisting of 22 males and 16 females were included in this study among which 23 patients had Type II axillary contractures and 15 had moderate flexion contractures at elbow joint. The post-operative abduction achieved at shoulder joint had a mean of 168° whereas extension achieved at elbow had a mean of 175°. The functional and aesthetic results were satisfactory. Conclusion: The choice of surgical procedure for reconstruction of post-burn upper extremity contractures should be made according to the pattern of scar contracture and the state of surrounding skin. The choice of subcutaneous pedicle propeller flap should be emphasised because of the superior functional results of flap as well as ease to learn it. Moreover, the modification of propeller flap described achieves better results in terms of scar healing. There is an inter-positioning of healthy skin in between the graft, so it prevents scar band formation all around the flap.

Island Flap Reconstruction of the Web Space in Congenital Incomplete Syndactyly

2004 ◽  
Vol 29 (4) ◽  
pp. 377-380 ◽  
Author(s):  
M. D. BRENNEN ◽  
B. J. FOGARTY
Keyword(s):  
Skin Grafts ◽  
Residual Defect ◽  
Aesthetic Results ◽  
Operative Planning ◽  
Flap Design ◽  
Web Space ◽  
A New Technique ◽  
Complex Planning ◽  
The Web

A number of techniques have been described for the correction of incomplete syndactyly, some of which may produce obvious dorsal scarring of the fingers or hand while others rely on the use of skin grafts. Many of the methods require complex planning. We present our experience of a new technique which simplifies the operative planning, allows a natural looking web space to be reconstructed with minimal dorsal scarring and should minimize the need for skin grafts. Seven patients (nine webs) who underwent correction of incomplete syndactyly were reviewed (follow-up range, 6–32 months). Only one patient early on in the series required a small skin graft to cover a residual defect, following which modifications to the flap design were made. All the web spaces healed without complication and at review there were good functional and aesthetic results.

scholarly journals Interest of Thin Skin Flaps in the Treatment of Postburn Cervical Contractures: About Five Cases

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
I. Ghorbel ◽  
F. Bouaziz ◽  
H. Bellaaj ◽  
S. Moaalla ◽  
Kh. Ennouri
Keyword(s):  
Young Adults ◽  
Observational Study ◽  
Plastic Surgery ◽  
Functional Results ◽  
Skin Flaps ◽  
Aesthetic Results ◽  
Thin Skin ◽  
The Aesthetic ◽  
Surgery Department

Objectives. The use of thin skin flaps in the reconstruction of postburn cervical contractures associated with functional impacts. Material and Methods. We conducted a descriptive observational study on about five patients who had reconstruction of postburn cervical contractures using various thin skin flaps in a plastic surgery department. The follow-up period was ranged from 12 to 18 months. We determined the characteristics of the retraction according to the Vandenbussche classification, the indications of the flaps, and the functional and aesthetic results. Results. Most of our patients were young adults presenting segmental retraction of the neck associated with moderate functional impact. The occipito-cervico-dorsal flap was used in three cases. The occipito-cervico-shoulder flap was used in two cases. The aesthetic and functional results were satisfactory for all patients, but a “neck-collar” aspect of the cervical-chin angle was noticed. Conclusion. Postburn cervical contractures remain frequent. Their reconstruction is a difficult process as it is ideally done with a skin similar to the original one. The use of thin skin flaps seems to be an excellent option.

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