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.     

用人工真皮重建伴颅骨外露的全层头皮缺损

目的:伴有颅骨外露的头皮全层缺损治疗仍然困难。笔者介绍用皮耐克(人工真皮)覆盖外露的颅骨、重建头皮的临床经验。方法:3例患者,因头皮肿瘤切除,出现颅骨外露,平均颅骨外露面积是89cm2。将颅骨外板打磨后,用人工真皮覆盖,3周后,创基肉芽组织生长良好,移植自体中厚皮。结果:3例患者,移植的中厚皮片全部成活。随访1～3个月,无皮肤破溃、水疱等。结论:人工真皮能够提供一个较厚、耐磨的颅骨组织覆盖,是一种简单有效的处理头皮全层缺损伴颅骨外露方法。     

Resurfacing denuded areas of the beard with full thickness scalp grafts

Reconstruction of a beard-bearing area, such as the upper lip, necessitates hair-bearing grafts no thicker than a full thickness skin graft, in order to allow for normal movement. In the normal scalp, however, most of the follicles reach into the subcutaneous fat. By preoperative epilation it seems possible to induce the catagen phase of the hair cycle during which the follicles migrate into the corium and thus will be transplanted as complete morphological units. The clinical results support this concept.     

Split thickness hypothenar grafts for skin defects of the hand.

Split thickness hypothenar grafts provide excellent coverage for fingertips as well as other areas of the hand. The method is simple and readily applied in the emergency room with little additional equipment.     

Local flaps in the treatment of full thickness scalp defects secondary to advanced cutaneous malignancy. About 21 clinical cases

SUBJECT: The advanced tumors of the scalp can involve the calvarium, the dura and the cerebral tissue. The medium sized full thickness scalp defects secondary to the excision of such cutaneous malignancy can be successfully treated with local flaps coming from the remaining scalp if these flaps are large and including at least one major pedicle of the scalp. The cranioplasty can be done immediately or secondarily. PATIENTS AND METHODS: From May 2001 to July 2006, 21 patients aged between 52 and 78 years old, suffering from advanced basal and squamous cell carcinomas with invasion of the calvarium in all cases, the dura in 1 case and the cerebral tissue in 2 cases have benefited from an excision of the scalp and calvarium with a margin between 1 and 3 cm. The secondary defects measured between 9 and 15 cm for the scalp and between 6 and 9 cm for the calvarium. In 1 case, the dura was resected and reconstructed with a fascia lata graft. The flaps used were: a single pedicled transposition flap based on one or two occipital pedicles in 10 cases--a bipedicled transposition flap based on the superficial temporal pedicles in 3 cases and on the frontal and occipital pedicles in 4 cases--a large rotation flap in 4 cases. These flaps were undermined under the galea without any galeotomies. Their donor sites were immediately grafted. The calvarium was reconstructed by a methylmetacrylate implant in 9 cases, simultaneously with these flaps in 4 cases and secondarily in 5 cases. RESULTS: There were no vascular problems in all these flaps--3 cases of infection in the simultaneous reconstruction of the scalp and calvarium are reported. The two patients with cerebral invasion are deceased 1 year after the surgery. The other patients are still alive without any recurrence or metastasis with a mean follow-up of 36 months. CONCLUSION: Such complex defects of the tumoral scalp can be reconstructed with large and axial local flaps of the remaining scalp with safety. The cranioplasty has to be delayed.     

Autologous cutaneous grafts for experimental reconstruction of facial cartilagineous defects: ideas and innovations

The aim of this paper is to report histological and biomechanical observations on autologous skin grafts that had been treated with a stabilized glutaraldehyde process in order to obtain elastic cartilage substitutes. Two parallel, para-midline full-thickness cutaneous rectangular grafts (1.5×3 cm) were harvested on the dorsum of 20 New Zealand rabbits. The 40 cutaneous grafts thus obtained were then immersed, for 30 min, into a solution of 25% glutaraldehyde, thoroughly rinsed with saline, and individually grafted subcutaneously at the level of the base of the homolateral ear. After 4 months, the grafts were harvested again in order to evaluate their histologic and tensiometric properties: The plasticity of the grafts resembled that of normal elastic cartilage (mean pliability=0.3335 N/cm), while, at the histological level, only little change was noted in any of the grafts. All the grafts were surrounded by a thick connective capsule. Apart from some areas of intercellular edema, there was no evidence of any cell infiltration or tissue growing into the grafts. The cell architecture appeared intact. In our experience, autologous skin grafts may be permanently fixed (and their complex architecture preserved) in order to obtain, in a rabbit model, stable cartilaginous bioprostheses.     

Dermabrader: a different use in preparing scalp defects without periosteum for immediate skin grafting

Summary To cover a very large scalp defect, one may mobilize the remaining scalp to effect closure. However, sometimes skin grafting may be unavoidable. For this procedure, the prepared raw surface should be smooth and well vascularized. To achieve this in one case, a dermabrader has been used as an osteoabrader to remove the outer table to provide a surface with punctate bleeding. A good result was obtained with minimal hospitalization.     

HTR® polymer facial implants: A five-year clinical experience

Forty-three patients at two different international sites underwent onlay facial augmentation of the malar, paranasal, and chin regions using 61 HTR polymer preformed implants. All implants were placed intraorally and rigidly fixed with a titanium screw. Over postoperative periods ranging from two to five years, one implant was removed because of infection. Two other implants in patients with rheumatic and connective tissue disease were removed because of persistent pain and erythema. Another peri-implant infection was treated successfully without removal. Oneyear postoperative radiographs in patients with chin implants demonstrated no underlying bone resorption. This porous polymeric material appears to offer clinical results comparable to other alloplastic materials for onlay facial skeletal augmentation.     

The use of small deep grafts in the repair of surface defects

It has been said that the results obtained by the use of small deep grafts are never satisfactory; that small deep grafts, often incorrectly called pinch grafts, should never be the method of choice; that by the use of these grafts the donor site is made useless as the source of other grafts, and that the method is a surgical error.My experience has been that if small deep grafts are properly cut and are really small deep grafts; if they are used in the proper situation on a surface which is suitable for them; if they are properly spaced; if they are properly dressed; if the after-care is as it should be—the healing will be stable, strong and permanent, and there is no type of graft which gives more uniformly satisfactory results. Furthermore, small deep grafts will in many instances take on surfaces on which no larger graft could take.If the best results are to be obtained with small deep grafts, several points must be observed. The granulating surface on which the grafts are placed should be healthy, clean, flat, firm and rose pink in color. The grafts should be cut without unnecessary trauma, should include the full thickness of the skin at its center and should be no larger than 5 mm. in diameter. In cutting, a narrow rim of undisturbed epidermis should be left between the little pits, and in this way a large number of grafts can be obtained from a very small area of skin. In fact, a greater raw area can be healed from a smaller skin source than by any other method. The grafts should preferably be placed on the granulations with a space of about 5 mm. between them, although frequently excellent results are obtained when the spaces are greater. They should be pressed down firmly so that the thin edges will uncurl and so that every portion of the graft will be in close contact with the granulating surface. The grafts should be immobilized until the new blood supply is assured, and this is best accomplished by the closed method of dressing.My own experience and that of many other surgeons during nearly thirty years has convinced me that the method is that of choice in a great many instances, and I feel that those who have not had good results, either do not know how to use this type of graft or do not take the trouble to use it properly.In my own work I use small deep grafts constantly, with the greatest satisfaction, and find the method indispensable when dealing with large losses of surface tissue and in solving some of the complicated problems of wound healing