Comparative evaluation of three methods of skin graft fixation for split thickness skin graft after release of post burn contracture of the neck |
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| Affiliation: | 1. Dept. of Plastic Surgery, Hi-Tech Medical College, Bhubaneswar, Odisha 751025, India;2. Dept. of Burns, Plastic & Maxillofacial Surgery, VMMC & Safdarjung Hospital, New Delhi 110029, India;1. Burn Center, Red Cross Hospital, Beverwijk, The Netherlands;2. Department of Traumasurgery, Leiden University Medical Center, Leiden, The Netherlands;3. Burn Center Maasstad Hospital, Rotterdam, The Netherlands;4. Amsterdam UMC, Free University Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands;5. Association of Dutch Burn Centers, The Netherlands;6. Department of Public Health Erasmus MC, Rotterdam, The Netherlands;7. Burn Center, Martini Hospital, Groningen, The Netherlands;1. Department of Dermatology, University of California, Davis, Sacramento, California;2. California Skin Institute, Carmel, California;3. Department of Dermatology, Keck School of Medicine at University of Southern California, Los Angeles, California;4. Department of Biological Science, California State University, Sacramento, California;5. Pacific Skin Institute, Sacramento, California;1. Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BR. Divisao de Cirurgia Plastica e Queimaduras;2. Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR. Laboratorio de Biologia Celular, LIM59, Departamento de Patologia;1. Assistant Dentist, Dental Practice Dr Schumacher, Unna, Germany;2. Professor and Chair, Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of Aachen University (RWTH), Aachen, Germany;3. Professor and Former Chair, Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of Aachen University (RWTH), Aachen, Germany;4. Professor and Chair, Institute of Medical Statistics, University Hospital of Aachen University (RWTH), Aachen, Germany;6. Assistant Professor, Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of Aachen University (RWTH), Aachen, Germany;5. Department Head, Department of Oral, Maxillofacial and Plastic Facial Surgery, Heinrich Braun Hospital, Zwickau; Lecturer, Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of Aachen University (RWTH), Aachen, Germany |
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| Abstract: | ObjectivesSplit thickness skin graft is an essential component of release of post burn contracture of neck. There are many methods of fixation of skin grafts; however, there is lack of objective comparison between different techniques. This study has been designed to compare three commonly used techniques of split thickness skin graft fixation methods. Surgical time, advantages, cost factor and post-operative outcome have been compared amongst three techniques.MethodsA randomized interventional comparative study was conducted to compare three methods of skin graft fixation in patients of 10–50 years age group, with contracture of more than 3 month duration having more than 100 cm2 skin defects after contracture release. Resurfacing of the defects after contracture release was carried out in all the groups using autologous split skin grafts. Patients were included in three groups; Group 1: tie over method, Group 2: skin stapler fixation and Group 3: Cyanoacrylate glue fixation.ResultsMean duration of fixation procedure was 34 min in tie over group, in skin stapler group 7 min and in cyanoacrylate group 12 min. Mean cost of fixation material was 10.23 USD in tie-over group, 11.23 USD in stapler group and 40.06 USD in cyanoacrylate group. Mean score of pain/discomfort (visual analog score) on dressing removal in tie-over group was 3, for skin stapler group was 2.9 and that for cyanoacrylate glue group was 1.8. mean graft take was found to be 90.1% in tie-over group, 94.1% in skin stapler group & 93.8% in cyanoacrylate glue group. On logistic regression analysis, keeping all the variables constant in the groups the complications as the outcome variable, three groups are comparable. The need for regrafting remains inconclusive.ConclusionsSkin stapler method for skin graft fixation was least time consuming, affordable and highly reliable when graft take success was considered. Cyanoacrylate glue fixation method was least painful and reliable in terms of graft take success though costlier than other two |
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| Keywords: | Post burn neck contracture Skin grafting Graft fixation methods Tie over dressing Skin stapler Cyanoacrylate glue |
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