Squamous cell carcinoma of skin developing in a skin graft donor site

We report a case of squamous cell carcinoma of the skin of the right ring finger which was treated by excision and split skin grafting. Three months later the patient presented with a further lesion at the margin of the skin graft donor site on the right thigh. Excision biopsy of this second lesion revealed a squamous cell carcinoma of a similar pathological appearance to the original lesion. We have been unable to trace any previous similar reports. A possible pathological basis for the sequence of events is discussed.     

Scar carcinoma arising acutely in a skin graft donor site

Scar carcinoma is an uncommon but not rare lesion. Although generally appearing after a long latent period, an acute form exits. In this case an acute squamous cell carcinoma appeared in a skin graft donor site at about 6 weeks, and was removed at 12 weeks.     

Australasian survey of split skin graft donor site dressings

BACKGROUND: There is an ever increasing array of products available for wound dressings. The aim of the present study was to establish which dressings should be used as standard controls for future studies; what factors are regarded as most important in assessing a dressing; what the level of satisfaction is with the available products; what the strengths and weaknesses of the commonly used dressings are; and what dressings would be preferred if cost were no issue. METHODS: A postal survey was sent to every plastic and reconstructive surgeon registered in Australasia (n = 217). A total of 53% responded. RESULTS: The most commonly used dressing type overall is the calcium alginates, despite the fact that they were not the highest performing dressings. This is also the most commonly used in Australia. In contrast scarlet red is still used most commonly in New Zealand. The level of satisfaction with the most commonly used dressing varied very little. The factor regarded most important was patient comfort level. A profile of the commonly used dressing was constructed. Calcium alginates and or scarlet red should be used as the control for new product comparisons. CONCLUSIONS: Most of the respondents were satisfied with their preferred dressing and were not interested in trying alternative dressings.     

The preputium: an overlooked skin graft donor site

Plastic surgeons often encounter tissue defects consisting of the superficial layer of the skin. Fortunately, many of these defects are reconstructed easily with skin grafts. The authors have used the preputium as a skin graft for the reconstruction of skin defects of various sizes and locations in children. The defect size ranged from 2.3 x 4.0 cm to 4.8 x 6.5 cm. The average defect size was 3.5 x 5.5 cm. The defects were caused from trauma, acute burn, and release of burn contractures, and were located in the lower extremity, upper extremity, and scalp. All patients were treated successfully. No complications of the donor area or recipient area were seen. The prepuce should be included as an additional tool in the reconstructive surgeons armamentarium because of its many advantages, including easy harvest, high viability and elasticity, and low donor area morbidity.     

碱性成纤维细胞生长因子对取皮创面的临床治疗观察

目的　报道重组碱性成纤维细胞生长因子对取皮创面愈合的影响。方法　 30例患者取皮后创面应用碱性成纤维细胞生长因子 (治疗组 )及生理盐水 (对照组 ) ,创面暴露。结果　治疗组 (11.73± 0 .9)天比对照组 (15 .2 3±3.8)天在愈合时间上有显著差异 (P <0 .0 1)。结论　碱性成纤维细胞生长因子能促进取皮后供区的愈合 ,使用方便 ,疗效满意     

Novel skin graft donor site for the scalp transposition flap

Transposition scalp flaps are a versatile solution for soft-tissue cover in a multitude of scalp defects. They are frequently used to reconstruct larger skin cancers that involve the outer table of the cranium in addition to covering neurosurgical bony defects and hardware. The transposition flap requires the donor site to be grafted using a split-thickness graft, which results in a secondary wound elsewhere on the body, commonly the lateral thigh. Although quite routine in such surgery, this procedure does require another body area to be prepared and draped. We sought to streamline this procedure with an adjustment to the location of the donor site. In harvesting the graft from the skin of the flap itself, we localised all surgery to one area, which has a number of logistical and patient-care advantages. Our experience has shown significant benefits from this technique and this is now our chosen and recommended donor site for these reconstructions.     

Gene expression profiling of negative-pressure-treated skin graft donor site wounds

Negative-pressure wound therapy (NPWT) is widely used to improve skin wound healing. Although NPWT has been studied as a treatment for wound closure and healing, the molecular mechanisms explaining its therapeutic effects remain unclear. To investigate the effect of NPWT on gene expression, and to discover the genes most dominantly responding to this treatment during skin wound healing, we applied negative pressure on split-thickness skin graft donor sites from the first postoperative day (POD) to the seventh POD. Biopsies were collected from 4 NPWT-treated and 2 control patients. Two biopsy samples were taken from each patient: one from intact skin before graft harvesting, and one on the seventh POD from the donor site wound. Genome-wide microarrays were performed on all samples. Gene expression changes on the seventh POD were compared between NPWT and control patients, and were analyzed for statistical significance. In addition, we analyzed wound exudates for volume, and for concentrations of leukocytes, erythrocytes, and haemoglobin. NPWT induced major changes in gene expression during healing. These changes ranged from 10-fold induction to 27-fold suppression. The genes most induced were associated with cell proliferation and inflammation, and the most down-regulated genes were linked to epidermal differentiation. Our results provide the first insight into the molecular mechanisms behind NPWT, and suggest that NPWT enhances specific inflammatory gene expression at the acute phase associated with epithelial migration and wound healing. However, its continued use may inhibit epithelial differentiation.     

Calcium alginate dressing accelerates split skin graft donor site healing

A prospective controlled trial of calcium alginate compared with traditional dressing of paraffin gauze on split skin graft (SSG) donor sites had to be abandoned after 15 patients as there was consistently better healing under the calcium alginate. The study was continued, on every patient requiring split skin grafting, to assess calcium alginate from the point of view of patient comfort, ease of dressing and quality of regenerated skin. In 107 patients with 130 SSG donor operations, there was a statistically highly significant decrease in average time to complete healing (from 10 down to 7 days), and also significantly better patient comfort. The alginate dressings were easy to use and the quality of the new skin significantly better than that seen under paraffin gauze dressings.     

表皮生长因子不同用药方法对供皮区治疗的作用

目的探索外用重组人表皮生长因子治疗供皮区创面的最佳用药方法,以指导临床应用.方法设生理盐水治疗为自身对照,选择三种用rhEGF的方法(每日1次法,每日3次法,每日1次加保湿法),进行供皮区创面愈合的比较性研究.结果和对照组相比,rhEGF可有效促进供皮区创面愈合(P＜0.01).三种用药方法之间比较,差别具有显著性意义(P＜0.05),每日1次加保湿法和每日3次法均能进一步缩短创面愈合时间.结论从方便、经济与合理的角度考虑,每日1次加保湿法为临床首选.     

表皮生长因子不同用药方法对供皮区治疗的作用

目的　探索外用重组人表皮生长因子治疗供皮区创面的最佳用药方法 ,以指导临床应用。方法　设生理盐水治疗为自身对照 ,选择三种用rhEGF的方法 (每日 1次法 ,每日 3次法 ,每日 1次加保湿法 ) ,进行供皮区创面愈合的比较性研究。结果　和对照组相比 ,rhEGF可有效促进供皮区创面愈合 (P <0 .0 1 )。三种用药方法之间比较 ,差别具有显著性意义 (P <0 .0 5) ,每日 1次加保湿法和每日 3次法均能进一步缩短创面愈合时间。结论　从方便、经济与合理的角度考虑 ,每日 1次加保湿法为临床首选     

新型敷料在供皮区创面的应用

在烧伤整形外科中,游离皮片移植术后存在供皮区本身的修复问题,如取皮留下的创面过大,该创面愈合时间较长,容易继发感染,形成瘢痕挛缩,最终影响美观甚至带来功能障碍等风险。目前,临床治疗中为促进供皮区创面良好愈合,减少瘢痕的增生,常常通过对供皮区创面应用敷料达到这一目的。随着对创面愈合机制的研究深入,人们认识到使用敷料不仅能覆盖创面,而且能促进创面愈合。在这种观点的指导下,人们尝试在创面运用不同的敷料。     

Modification of split-thickness skin graft: cosmetic donor site and better recipient site

The author reports an alternative method of caring for the donor sites of split-thickness skin graft that involves the immediate return of superficial thin-layer split skin graft to the donor sites while using the deep split-thickness skin graft for replacement over the defects. The proposed method would decrease the morbidity associated with other established techniques of donor site management, including prolonged healing time, fluid loss, discomfort, pain, and undesirable cosmetic results. As for the recipient site, satisfactory cosmetic effects and less pigmentation changes could be achieved with this type of simple modification of a laminated graft.     

Suboptimal results in full thickness skin graft urethroplasty using an extrapenile skin donor site

We performed 22 full thickness skin graft urethroplasties for treatment of urethral stricture disease or hypospadias. Excellent results were achieved in 18 cases in which a penile skin donor site was used. Three failures occurred in 4 cases in which the full thickness graft was raised from the inner aspect of the upper arm. These results suggest caution when extrapenile skin is used for such repairs.     

Enhanced cryoprecipitate for skin graft and donor site wound healing in pigs

Due to similarities in skin characteristics, the authors hypothesise that a pig model would most accurately show the ability of autologous, enhanced cryoprecipitate (eCryo) to improve the wound healing of split‐thickness skin grafts (STSGs) and corresponding donor sites. Fifty‐two STSGs (5 × 5 cm) were fashioned and treated according to a randomised protocol with an autologous eCryo‐treated and a control group. Macroscopic assessment, histological evaluation and cellular composition were completed at days 7, 14, 21 and 28. Thirty‐two donor sites were also created and assessed in a similar manner. Histologic analysis showed enhancement of healing over all time points for eCryo‐treated donor sites. All other results showed no statistically significant improvement with the use of eCryo. Autologous cryoprecipitate appears to be a safe, inexpensive and easy‐to‐use alternative to fibrin glue, which carries risks and is, in many cases, prohibitively expensive. Further studies are necessary to evaluate the full potential of eCryo. Interestingly, eCryo application may improve donor site aesthetic appearance. We believe that a pig model most reliably simulates eCryo's behaviour in humans to accurately reflect its future clinical applicability.