A Comparison of Full and Split Thickness Skin Grafts in Radial Forearm Donor Sites

To formally evaluate the functional and aesthetic outcomes between full versus split thickness skin graft coverage of radial forearm free flap donor sites. A retrospective chart review of 47 patients who underwent pedicled or free radial forearm free flap reconstruction from May 1997 to August 2004 was performed. Comparisons were made between patients who had donor site coverage with split thickness skin grafts (STSG) or full thickness skin grafts (FTSG). There was no statistically significant difference between the STSG and FTSG in the number of post-operative dressings, incidence of tendon exposure, time to healing at the skin graft donor site, and time to healing at the skin graft recipient site. The questionnaire data showed there was a trend toward higher scores with the radial forearm scar aesthetics and satisfaction in the FTSG group. Full thickness skin graft coverage of radial forearm free flap donor site is superior to split thickness skin graft coverage in terms of aesthetic outcome, and has no statistically significant difference in terms of tendon exposure, time to healing at the skin graft donor site, time to healing at the skin graft recipient site, or post operative pain.     

Analysis of real-world length of stay data and costs associated with use of autologous skin cell suspension for the treatment of small burns in U.S. centers

BackgroundAutologous skin cell suspension (ASCS) is a treatment for acute thermal burn injuries associated with significantly lower donor skin requirements than conventional split-thickness skin grafts (STSG). Projections using the BEACON model suggest that among patients with small burns (total body surface area [TBSA]<20 %), use of ASCS± STSG leads to a shorter length of stay (LOS) in hospital and cost savings compared with use of STSG alone. This study evaluated whether data from real-world clinical practice corroborate these findings.Materials and methodsElectronic medical record data were collected from January 2019 through August 2020 from 500 healthcare facilities in the United States. Adult patients receiving inpatient treatment with ASCS± STSG for small burns were identified and matched to patients receiving STSG using baseline characteristics. LOS was assumed to cost $7554/day and to account for 70 % of overall costs. Mean LOS and costs were calculated for the ASCS± STSG and STSG cohorts.ResultsA total of 151 ASCS± STSG and 2243 STSG cases were identified; 63.0 % of patients were male and the average age was 44.2 years. Sixty-three matches were made between cohorts. LOS was 18.5 days with ASCS± STSG and 20.6 days with STSG (difference: 2.1 days [10.2 %]). This difference led to bed cost savings of $15,587.62 per ASCS± STSG patient. Overall cost savings with ASCS± STSG were $22,268.03 per patient.ConclusionsAnalysis of real-world data shows that treatment of small burn injuries with ASCS± STSG provides reduced LOS and substantial cost savings compared with STSG, supporting the validity of the BEACON model projections.     

Involvement of Keratinocyte Activation Phase in Cutaneous Graft Healing: Comparison of Full-Thickness and Split-Thickness Skin Grafts

BACKGROUND: Little is known about keratinocytic activation in the graft take and healing process. OBJECTIVE: To investigate the clinical and molecular differences between pure epidermal sheet graft (PESG), split-thickness skin graft (STSG), and full-thickness skin graft (FTSG). METHODS: Three different thickness skin grafts (PESG, STSG, and FTSG) were performed onto three kinds of porcine wounds: shallow, deep, and full. Graft take, contraction, and Ki-67 and beta1 integrin expression in epidermis were studied. RESULTS: All grafts took well. As expected, full wounds covered by PESG and STSG contracted more than those covered by FTSG, whereas shallow wounds covered by FTSG contracted more than those covered by STSG. No difference in contracture was observed among deep wounds covered by PESG, STSG, and FTSG. Up-regulation of Ki-67 and beta1 integrin expression was greater in PESG and STSG, compared with little expression in FTSG. CONCLUSION: The keratinocytic activation phase may occur both in the STSG and PESG healing process, as well as serum imbibition, inosculatory, and revascularization phases.     

The use of split-thickness dermal grafts to resurface full thickness skin defects

Coverage of large burns may be difficult when skin graft donor sites are limited. This study explored the use of the split-thickness dermal graft (STDG), as an alternative to the standard split-thickness skin graft (STSG). STSGs and STDGs were compared experimentally by their ability to resurface full thickness skin defects in a pig model. Both types of grafts were harvested from the backs of six pigs and placed on full thickness wounds. From the same donor site a 0.012 in. thick STSG and another two 0.012 in. thick STDGs were harvested. Thus the deep surface of grafts measured 0.012, 0.024 and 0.036 in. from the skin surface, respectively. All grafts were placed on 6 cm×6 cm full thickness wounds. The donor areas healed at 1 week. Epithelialization of the STDGs, was assessed by computerized planimetry, and was 100% at 4 weeks. Graft biopsies revealed that STSGs were significant thinner than STDGs at 1 week (P=0.0422, 0.0135), 2 weeks (P=0.0240) and 4 weeks (P=0.0516, 0.0425). We conclude that STDGs my provide definitive coverage of full thickness skin deficits in a pig wound model.     

Demonstration of the safety and effectiveness of the RECELL® System combined with split-thickness meshed autografts for the reduction of donor skin to treat mixed-depth burn injuries

IntroductionSplit-thickness skin grafts (STSG) are the standard of care (SOC) for burns undergoing autografting but are associated with donor skin site morbidity and limited by the availability of uninjured skin. The RECELL^® Autologous Cell Harvesting Device (RECELL^® System, or RECELL) was developed for point-of-care preparation and application of a suspension of non-cultured, disaggregated, autologous skin cells, using 1 cm² of the patient’s skin to treat up to 80 cm² of excised burn.MethodsA multi-center, prospective, within-subject controlled, randomized, clinical trial was conducted with 30 subjects to evaluate RECELL in combination with a more widely meshed STSG than a pre-defined SOC meshed STSG (RECELL treatment) for the treatment of mixed-depth burns, including full-thickness. Treatment areas were randomized to receive standard meshed STSG (Control treatment) or RECELL treatment, such that each subject had 1 Control and 1 RECELL treatment area. Effectiveness measures were assessed and included complete wound closure, donor skin use, subject satisfaction, and scarring outcomes out to one year following treatment.ResultsAt 8 weeks, 85% of the Control-treated wounds were healed compared with 92% of the RECELL-treated wounds, establishing the non-inferiority of RECELL treatment for wound healing. Control-treated and RECELL-treated wounds were similar in mean size; however, mean donor skin use was significantly reduced by 32% with the use of RECELL (p < 0.001), establishing the superiority of RECELL treatment for reducing donor skin requirements. Secondary effectiveness and safety outcomes were similar between the treatments.ConclusionsIn combination with widely meshed STSG, RECELL is a safe and effective point-of-care treatment for mixed-depth burns without confluent dermis, achieving short- and long-term healing comparable to standard STSG, while significantly decreasing donor skin use.     

Medium thickness plantar skin graft for the management of digital and palmar flexion contractures

The fundamental principle of reconstruction is to replace the lost tissue with similar tissue. Because of the unique similarities in characteristics, plantar skin is an excellent donor area for skin grafting for the palmar aspect of the digits and hand. It provides an ideal color and texture match and long durability with an inconspicuous donor site. However, the use of plantar skin in management of digital and palmar defects is only rarely reported in the literature. Doubts were raised on donor site healing and incidence of recurrence of contracture. There are reports of using full thickness skin graft and dermal grafting from planta in similar cases. We have used medium thickness split grafts from sole of foot in correcting 262 cases of flexion contracture of digits and palms. Thick split skin grafts, full thickness grafts, local flaps and Z plasties were used in numbers of other cases. The technique of plantar skin grafts, application and results with reference to take of graft, quality of skin, donor area healing and recurrence are discussed and compared with available methods and studies.     

Use of a topical mix of lidocaine and prilocaine during split-thickness skin graft harvest improves postoperative recovery—A prospective randomized controlled trial

PurposeTo provide evidence of efficacy and postoperative benefit of topical anesthesia (TA) for harvesting split-thickness skin graft (STSG) in an Asian population.Materials and methodsPatients with well-granulating wounds with skin grafting were randomized into TA or general anesthesia (GA) groups. In the TA group, an eutectic mixture of lidocaine and prilocaine (EMLA) was applied. Perioperative heart rate, postoperative donor site pain, adverse effects, patients’ satisfaction, duration of surgery, and operation room (OR) stay duration were recorded.ResultsThirty-nine patients (19 males, 20 females; mean age 54.9 ± 17.8) were included. Twenty underwent TA and 19 underwent GA for STSG. The TA group patients had tolerable pain during skin graft harvesting (VAS, 0.85 ± 1.5). Average EMLA exposure duration was 180.3 ± 65.8 min, and the amount applied was 1.72 ± 0.43 g/10 cm². The TA group had lower donor site pain score at one hour postoperatively (1.34 ± 1.49 vs 3.08 ± 1.90, p = 0.005), lower OR stay duration (36.5 ± 6.5 min vs 65.1 ± 17.2 min, p < 0.001) and less adverse effects than the GA group.ConclusionHarvesting STSG under TA with EMLA is an effective and efficient approach for most Asian patients with less early postoperative donor site pain and fewer adverse effects.     

Bold to do — bald to be? Outcomes decades after harvesting the scalp in burned children

BackgroundThe scalp is the only hidden donor site for split thickness skin grafts. Nevertheless, it is underappreciated due to fear of iatrogenic scarring alopecia. Long-term data showing whether androgenetic hair loss can reveal previously hidden scarring alopecia is unavailable. We aimed to evaluate results and patient satisfaction up to 30 years after skin harvest from the scalp.MethodsBurn patients, hospitalized between 1977 and 1987 at the University Children’s Hospital Zurich with scalp skin harvest and currently over 30 years old, were studied. Medical records and patient satisfaction were analyzed, and a clinical scalp examination was performed.ResultsThirty-two patients (18 males, 14 females) with a current age of 34.13 ± 3.42 years participated. Mean follow-up time was 27.09 ± 3.04 years. Fifty-four scalp harvests were performed with 1.69 ± 0.96 sequential harvests. Hair growth was considered normal in 97% patients. Androgenetic alopecia (AGA) type Norwood II–VI was seen in 11 patients. Scalp examination revealed 11 unknown likely harvest-related alopecias with a mean size of 0.7 cm².ConclusionsLong-term morbidity of scalp skin harvest and the risk of clinically significant alopecia is very low while patient satisfaction is high. AGA is unlikely to reveal harvest damage previously hidden by regrown hair.     

Radial forearm free flap donor site outcomes comparison by closure methods.

OBJECTIVE: To compare the functional and aesthetic outcomes of radial forearm free flap (RFFF) donor sites reconstructed with full-thickness skin graft (FTSG), split thickness skin graft (STSG) alone, and STSG overlying an acellular dermal matrix (AlloDerm). STUDY DESIGN AND SETTING: A cross-sectional cohort study at a tertiary care hospital. RESULTS: Twenty-five head and neck cancer patients who underwent reconstruction with RFFF completed the evaluations (STSG = 10, FTSG = 8, STSG with AlloDerm = 7). Subjective evaluations of postoperative function by questionnaires showed no significant differences among the 3 groups (P = 0.93). In blinded evaluations by surgeons, the STSG group obtained the highest aesthetic outcome score (3.39 of 5.0), followed by FTSG (2.89) and STSG with AlloDerm (2.80). However, the difference was not statistically significant (P = 0.32). Objective measurements of postoperative function by certified occupational therapists were comparable among the 3 groups with the exception of a mildly decreased range of wrist flexion (P = 0.036) and ulnar deviation (P = 0.016) in the FTSG group. CONCLUSIONS: The 3 methods of reconstruction have comparable postoperative functional and aesthetic outcomes. SIGNIFICANCE: Each of the 3 methods of reconstruction has low morbidity and satisfactory aesthetic and functional outcomes.     

Human hypertrophic scar‐like nude mouse model: Characterization of the molecular and cellular biology of the scar process

Hypertrophic scar (HTS) following thermal injury and other forms of trauma is a dermal fibroproliferative disorder that leads to considerable morbidity. Because of the lack of an ideal animal model, research is difficult. We have established an HTS model that involves transplanting human split‐thickness skin graft (STSG) or full‐thickness skin graft (FTSG) onto the backs of nude mice. The animals developed raised, firm, and reddish scars 2 months following transplantation. Histology and micromeasurement indicate raised, thickened engrafted skin with STSG and FTSG. In contrast, thickening was not observed with full‐thickness rat skin grafts used as controls. Masson's trichrome staining demonstrates increased accumulations of collagen fibrils in the dermis in both scars grafted with STSG and FTSG. Staining cells with toludine blue and an antibody for F4/80 showed an increase in the infiltration of mast cells and macrophages. Quantification of fibrocytes reveals increased fibrocytes. Moreover, STSG grafted skin had significantly more macrophages, mast cells, and fibrocytes than FTSG. Real‐time polymerase chain reaction analysis showed significantly elevated mRNA levels for type I collagen, transforming growth factor‐β, connective tissue growth factor and heat shock protein 47 in both types of engrafted skin. These data demonstrate that human skin grafted onto nude mice develops red raised and thickened scars having intrinsic properties that closely resemble HTS formation as seen in humans. Interestingly, STSG developed more scar than FTSG. Furthermore, inflammatory cells and bone marrow‐derived fibrocytes may play a critical role in HTS development in this animal model.     

An evaluation of five different dressing materials on split‐thickness skin graft donor site and full‐thickness cutaneous wounds: an experimental study

The objective of this study was to investigate the healing effect of five different products on split‐thickness skin graft (STSG) donor sites and full‐thickness cutaneous wounds (FTCWs) using an occlusive dressing model. Six groups were included: 1 control and 5 experimental groups, with a total of 24 rats, using an occlusive dressing model. STSG donor sites and FTCWs were established in two separate areas, to the right and left on the animals' backs. Wound sites were dressed with one of the following materials: fine mesh gauze, microporous polysaccharide hemosphere (MPH), clinoptilolite, alginate, hydrogel or biosynthetic wound dressing (Biobran^®). These materials were compared in terms of healing rate, healing quality and histopathological findings. Occlusive dressings were applied to each wound on days 0, 3, 5, 7, 10 and 14. Area measurements were taken using images of each dressing. The alginate and clinoptilolite groups gave the best healing rate results for both STSG donor sites (P = 0·003) and FTCWs (P = 0·003). MPH came third in each group. The alginate group produced better results in terms of healing quality criteria, followed by hydrogel, MPH, clinoptilolite and Biobran^®, in that order. Statistically significant results were obtained in all groups compared to the control group (P < 0·0007). Rapid and good healing quality for both the STSG donor sites and FTCWs were obtained with alginate. Healing with clinoptilolite and MPH was rapid, but poor quality, while slower but good healing quality was obtained with hydrogel. Slower and worse quality healing was obtained with Biobran^®.     

真皮生物模板对成纤维细胞生物学行为的影响

目的　研究真皮生物模板的应用对皮肤组织创伤修复过程中成纤维细胞 (fibroblast,FB)生物学行为的影响 ,探讨其在影响组织修复及减轻瘢痕形成中的作用机制。　方法　 SD大鼠 12 0只 ,在背部造成 2 .5 cm× 2 .5 cm的全层皮肤组织缺损创面 ,随机分为 4个处理组 ,即开放创面组、全厚皮移植组、刃厚皮移植组、复合移植组 (无细胞真皮基质 +刃厚皮移植 ) ,分别于术后 1、2、4、6及 12周取材。通过免疫组织化学及图像分析技术检测组织标本中肌成纤维细胞 (myofibroblast,MFB)的标志蛋白—— α平滑肌肌动蛋白 (α smooth muscle actin,α- SMA)的表达以及纤维连接蛋白(fibronectin,FN)、整合素 α2 、β1 及转化生长因子 β1 (transforming growth factorβ1 ,TGF- β1 ) )的表达量。　结果　复合移植组 α- SMA在术后 1～ 12周低于开放创面组 ,术后 1、4、6周低于刃厚皮移植组 ,术后 2、12周高于全厚皮移植组(P<0 .0 5 ) ;复合移植组 FN在术后 1～ 12周低于开放创面组和刃厚皮移植组 ,术后 1～ 4周高于全厚皮移植组 (P<0 .0 5 ) ;复合移植组整合素 α2 在术后 1～ 12周低于开放创面移植组 ,术后 1～ 4周低于刃厚皮移植组 ,术后 1、2周高于全厚皮移植组 (P<0 .0 5 ) ;复合移植组整合素 β1 在术后 1～ 12周低     

Comparison of therapeutic effects between artificial dermis combined with autologous split‐thickness skin grafting and autologous intermediate‐thickness skin grafting alone in severely burned patients: A prospective randomised study

The purpose of this study was to evaluate the therapeutic effects of artificial dermis combined with autologous split‐thickness skin grafting (STSG) compared with autologous intermediate‐thickness skin grafting (ITSG) alone in severely burned patients. Fifty‐six severely burned patients admitted to our hospital from December 2017 to January 2019 were enrolled and evenly grouped according to the random number table method [AD‐STSG group: 28 patients, receiving the treatment of artificial dermis (AD) combined with autologous STSG; ITSG group: 28 patients, receiving autologous ITSG treatment alone]. The healing time and Vancouver Scar Scale (VSS) score of the donor area and graft area, survival rate and infection status of the autologous skin, psychological status (determined by Self‐rating Anxiety Scale and Self‐rating Depression Scale), and the activity of functional parts of all enrolled patients were included in the evaluation. General items of patients in AD‐STSG group and ITSG group, including age, sex, and degree of burn, were all comparable. A significantly shortened healing time of donor skin in AD‐STSG group was observed when compared with ITSG group (P < .05) while the recipient skin healed in the same tendency between the two groups. In addition, 21 days after the operation, AD‐STSG group presented with significantly higher survival rate of graft skin than ITSG group (P < .05) while same infection status was observed in the two groups. Significantly lower VSS scores were found in AD‐STSG group than that in ITSG group 3‐, 6‐ and 10‐months after operation (P < .05). Statistical difference regarding psychological status of patients from two groups was unobservable before operation while significantly lower Self‐rating Anxiety Scale (SAS) and Self‐rating Depression Scale (SDS) scores were found in AD‐STSG group than that in ITSG group 3‐, 6‐ and 10‐months after operation (P < .05). Also, AD‐STSG group presented improved mobility of functional part than that in ITSG group 10‐months after operation without statistical difference (P = .051). Artificial dermis combined with autologous split‐thickness skin grafting showed better therapeutic outcomes for the treatment of severely burned patients than autologous intermediate‐thickness skin grafting in terms of graft healing time, scar formation, psychological recovery, and perhaps in functional reconstruction.     

Medial plantar arch pinch grafts are an effective technique to resurface palmar and plantar wounds

Resurfacing the glabrous skin covering the human plantar and palmar surfaces constitutes a challenge to the plastic surgeon. Ideally, when this skin is lost, it should be replaced by the same type of tissue to provide strength, texture, and color match. This paper describes our experience with 9 palmar and plantar wounds which were successfully resurfaced with pinch grafts harvested from the non-weight-bearing area at the medial plantar arch of the foot. The patients were allowed to ambulate after surgery with partial or full weight-bearing as tolerated, the donor sites healed in 7 to 9 days without complication, and pinch grafts took 100%. The grafted wounds were completely covered with 1 application once the grafts reached confluence. Not only was pain eliminated, but the patients also were able to ambulate and use their hands with minimal reservation 2 weeks after surgery. Fourteen-month follow-up examination showed reliable and durable results, with perfect tissue match and no contracture. This technique is easy to perform in the office under local anesthesia. It is safe and well tolerated by the patient.     

Retroauricular full-thickness skin grafts in syndactyly repair: outcome and comparison with inguinal full-thickness skin grafts: retrospective (cross-sectional) study

Objective: Most surgeons recommend the use of full-thickness skin grafts for syndactyly repair. Common donor sites include the groin and elbow, but only one publication has previously mentioned retroauricular skin. No publication has compared the results for full-thickness skin grafts between retroauricular and other donor sites. This study aims at comparing functional and aesthetic outcomes and parents’ satisfaction with retroauricular vs inguinal full-thickness skin grafts. Methods: Eleven children with retroauricular and 15 with inguinal full-thickness skin grafts were included in this retrospective study. Examination included the Patient and Observer Scar Assessment Scale, parent satisfaction, and a colour match measurement. Results: Both pigmentation match and parents’ overall impression of the donor site were significantly better for retroauricular than for inguinal full-thickness skin grafts. Conclusion: Due to the excellent pigmentation match and the inconspicuousness of the donor site, this study recommends the use of retroauricular full-thickness skin grafts for syndactyly repair.     

Beauty of skin-grafted free muscle flaps in head and neck reconstruction

In the era of perforator flaps, muscle flaps might seem "out of fashion" for use in microvascular reconstructions. In this presentation, the advantages of pure muscle flaps covered with full-thickness (FTSG) or split-thickness (STSG) skin grafts employed in certain head and neck reconstructions shall be demonstrated. The free vastus lateralis muscle flap (n = 13) and latissimus dorsi flap (n = 1), covered with either FTSG (n = 8) or STSG (n = 6), were used for major head and neck reconstructions in a total of 13 patients. There was no revision, no partial flap necrosis, and no flap loss. All skin grafts healed in. After initial swelling, all flaps developed an adequate form according to the respective skin level, with adequate texture and color match. This was especially the case when FTSG was used. No cosmetic corrections were necessary. Donor-site morbidity was negligible. In conclusion, a free muscle flap covered with FTSG is a safe and fast reconstruction that provides good cosmetic and functional results, combined with negligible donor-site morbidity.     

The optimal timing of outpatient Biobrane™ application for superficial and mid dermal partial thickness burns: Evidence for the ‘12-hour rule’

BackgroundBiobrane? is a skin substitute used for the definitive management of partial thickness burns. No studies have examined the optimal timing of Biobrane? application in this setting. The purpose of this study was to determine whether there was a clinically significant difference in applying Biobrane to a superficial and mid dermal partial thickness burn within 12 h after burn.MethodsFrom August 2016–February 2017, 29 consecutive superficial and mid dermal partial thickness burn injuries were prospectively treated with Biobrane? within 12 h of the injury. This ‘early Biobrane?’ cohort was compared to a historical cohort of 148 patients who were treated with Biobrane? for superficial and mid dermal burns after 12 h after injury during 2015 to 2016. Multivariate regression analysis was used to determine the difference in time to re-epithelialisation and number of outpatient visits between the two cohorts.ResultsIn the ‘early Biobrane?’ group, the mean TBSA was 3.5 ± 2.7%. and the mean time to Biobrane? application was 7.1 ± 2.7 h after burn injury. The mean time to re-epithelialisation in this group was 9.1 ± 3.0 days, and no patients underwent skin grafting. In the ‘delayed Biobrane?’ group, the mean TBSA was 2.6 ± 2.8% and the mean time to Biobrane? application was 35.1 ± 21.4 h. The mean time to re-epithelialisation was 14.8 ± 8.7 days, with 3 patients undergoing skin grafting. Regression analysis demonstrated a statistically significant 63% reduction in time to re-epithelialisation (95% CI = 0.23–0.60; P < 0.0001) with early Biobrane? application.ConclusionPatients treated with application of Biobrane? within 12 h of superficial and mid dermal partial thickness burns have a statistically significant reduction in healing time when compared to patients treated with standard Biobrane? practice.     

Comparison of skin graft donor site management using oxidised regenerated cellulose (ORC)/collagen/silver-ORC with absorptive silicone adhesive border and transparent film dressing vs semi-occlusive dressings

Split-thickness skin grafts (STSG) are widely used in wound reconstruction. However, donor site wounds are created as a result. Traditionally, moist wound healing and transparent film dressings have been used to promote donor site wound healing. This retrospective study evaluated the use of oxidised regenerated cellulose (ORC)/collagen/silver-ORC dressing (ORC/C/Ag-ORC) with an absorptive silicone adhesive border dressing and transparent film dressing (treatment) compared with petrolatum-based gauze dressing (control) over donor site wounds. Patients underwent an STSG procedure between January and December 2020. Donor sites received treatment (n = 10) or control (n = 10) dressings. Dressing changes occurred as necessary. Time to epithelialisation, narcotic pain medication requirements, and the number of office/hospital visits were examined. Twenty patients were managed (9 males, 11 females, average age: 49.7 ± 13.9 y). Patient comorbidities included hypertension, diabetes, and hyperlipidemia. Wound types included traumatic and cancer excision. Time to epithelialisation was significantly reduced in the treatment group (11.1 ± 1.4 d vs 18 ± 2.4 d, P < 0.0001). The number of office visits for dressing changes was significantly lower in the treatment group (0.1 ± 0.3 vs 2 ± 0.7, P < 0.0001). No patients in the treatment group required a hospital visit, compared with 3 patients in the control group. One patient in the treatment group required narcotic pain medication, compared with 5 in the control group. In this patient population, the use of ORC/C/Ag-ORC, an absorptive silicone adhesive border dressing, and transparent film dressing resulted in a shorter time to epithelialisation and less analgesic requirement compared with petrolatum-based gauze dressing use.     

Investigation of the relationship between the thickness of the plantar calcaneonavicular ligament and plantar fascia in patients with plantar fasciitis

BackgroundAlthough patients with plantar fasciitis show spring ligament laxity, the thickness of the spring ligament in patients with plantar fasciitis remains unclear. This study aimed to elucidate the morphological characteristics of the spring ligament in patients with plantar fasciitis based on an ultrasound imaging system (US).MethodsThirty feet of 30 patients (painful group) diagnosed with plantar fasciitis at our hospital and thirty feet of 30 healthy volunteers (healthy group) without plantar pain were investigated. The thicknesses of both the spring ligament and plantar fascia were assessed via a US statistical comparison of the spring ligament and plantar fascia thickness between the painful and healthy groups. This was performed using Welch’s t-test, and the significance level was set at p < 0.01. In addition, Pearson’s correlation coefficient was calculated to assess the correlation between the spring ligament and plantar fascia thickness in the two groups, and the significance level was set at p < 0.01.ResultsThe spring ligament thickness in the painful group was significantly lower than that in the healthy group (p < 0.001). The thickness of the plantar fascia in the painful group was significantly greater than that in the healthy group (p = 0.03). In addition, the correlation between the spring ligament and plantar fascia thickness was moderately negative (r = −0.42, p = 0.001). The thicker the plantar fascia in the subjects, the thinner was the spring ligament.ConclusionsThe thickness of the spring ligament in patients with plantar fasciitis decreased. The thinning of the spring ligament was negatively correlated with the thickening of the plantar fascia as per the US evaluation. Based on the spring ligament thinning determined via US evaluation, interventions such as insoles from an early stage could prevent the onset of plantar fasciitis.     

Use of split thickness plantar skin grafts in the treatment of hyperpigmented skin-grafted fingers and palms in previously burned patients

Palmar and finger burns are often seen in children, and are usually as a result of contact burns. Some patients with deep hand burns are treated with full-thickness or split-thickness skin grafts. Skin graft is commonly used for hand reconstruction. However, the grafted skin would be more pigmented than the adjacent skin and different from skin texture.19 patients who showed hyperpigmentation after skin graft of finger and palm were treated. They all were injured by hand burns. We performed mechanical dermabrasion of the hyperpigmentation scar and application of a split thickness skin harvested from medial aspect of plantar of foot. Patients were asked about their level of satisfaction with the procedure and scar appearance was assessed using a five-point Likert scale. Also scar appearances were assessed using a Vancouver Scar Scale (VSS).The grafts were completely taken in all 19 patients. The color of the graft became similar to adjacent tissue. 15 patients were very satisfied, and four patients were relatively satisfied. The average score of the patients postoperative appearance improvement was 4.5 (improved to significantly improved postoperative appearance). Average VSS score was improved from 9.53 to 2.53. There was no hypertrophic scar on plantar donor site.The technique of the split-thickness plantar skin graft after mechanical dermabrasion is simple and provided good results in both color and texture for the patients who showed hyperpigmentation after grafting.