Dermatotraction: an effective technique for the closure of fasciotomy wounds: a preliminary report of fifteen patients

Dermatotraction was evaluated as an alternative technique for the closure of dermatofasciotomy wounds, with a review of literature and of our clinical experience. The dermatotraction technique provides closure of fasciotomy wounds and avoids the use of skin grafting. Patients treated with dermatofasciotomy for an acute compartment syndrome of the limbs, without obvious tissue necrosis and without shock or urgent life saving surgery, had their fasciotomy wound closed with dermatotraction with vessel loops, the skin approximation system, or the prepositioned intracutaneous suture. In our experience, the mean time to wound closure was nine days. Dermatotraction techniques that cause local skin compression should be avoided because skin necrosis might occur (skin approximation system). Dermatotraction with vessel loops or the prepositioned intracutaneous suture provides good skin apposition without the necessity for skin grafting.     

The prevalence of human papillomavirus DNA in benign keratotic skin lesions of renal transplant recipients with and without a history of skin cancer is equally high: a clinical study to assess risk factors for keratotic skin lesions and skin cancer

DNA of the epidermodysplasia-verruciformis associated subgroup of HPV (EV-HPV) is frequently detected in biopsies of premalignant lesions and nonmelanoma skin cancers of renal transplant recipients. The prevalence of EV-HPVs, however, has never been systematically studied in benign keratotic skin lesions of patients with or without a history of skin cancer. This study included 42 renal transplant recipients with and 36 without a history of skin cancer. A total of 176 skin biopsies were tested for the presence of EV-HPV DNA, using a nested polymerase chain reaction (PCR). METHOD: EV-HPV typing was done by comparison of the sequence of the amplified PCR products with the sequence of all known EV-HPVs. The natural history of the development of keratotic skin lesions was studied. The number of keratotic skin lesions rapidly increased after transplantation. This increase was most pronounced in patients who developed skin cancer. The prevalence of EV-HPV DNA in benign keratotic skin lesions was equally high in patients with and without a history of skin cancer, i.e., 55 and 53% in the two groups, respectively. A large variety of EV-HPV types was found, but of these none were predominantly present in either patient groups. A higher prevalence of EV-HPV DNA was found in benign skin lesions from sun-exposed sites, but only in patients with a history of skin cancer. The association between the number of keratotic skin lesions and the development of skin cancer strongly supports the hypothesis that EV-HPVs play a role in cutaneous oncogenesis. The equally high prevalence of EV-HPV infection in patients with and without a history of skin cancer, however, may indicate that besides EV-HPV infection, other factors, such as sun exposure may also be important.     

Fibroblasts improve performance of cultured composite skin substitutes on athymic mice

BACKGROUND: This study investigated the impact of adding human fibroblasts to a cultured composite skin substitute model of cultured human keratinocytes and acellular human dermis. METHODS: Skin substitutes were prepared by seeding human keratinocytes on the papillary side of acellular dermis with or without seeding fibroblasts on the reticular side. Performance of the grafts was compared both in vitro by histology and in vivo on surgically created full-thickness wounds on athymic mice. Graft size and contraction were measured and immunohistochemical stains were done to reveal vascularization. RESULTS: Skin substitutes with fibroblasts formed thicker epidermis than skin substitutes without fibroblasts. When transplanted onto athymic mice, skin substitutes with fibroblasts maintained their original size with only 2% contraction. In contrast, skin substitutes without fibroblasts showed 29% contraction. Vascular basement membrane specific mouse CD31staining and endothelial cell specific mouse collagen type IV staining revealed vascularization as early as 1 week posttransplant in grafts with fibroblasts, and was significantly higher than grafts without fibroblasts at 2 weeks. CONCLUSIONS: Addition of fibroblasts to keratinocyte based composite skin substitutes improves epidermis formation, enhances vascularization and reduces contraction.     

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目的 探讨如何降低乳腺癌根治术后皮瓣坏死的发生率。方法 对45例采用预防皮瓣坏死新方法的乳腺癌根治术病例与过去实施的1210例乳腺癌根治术病例进行了分组对比研究。结果 乳腺癌根治术后的皮瓣坏死率由原来的45%下降到目前的2%,经统计学处理,二者有极显著差异。结论 预防乳腺癌根治术后皮瓣坏死的关键是：防止腋下淋巴管瘘,腋下肋下置双管引流,合适的胸带包扎力,合理的皮瓣厚度及皮瓣缝合不能有张力。     

The use of a modified skin stretching device (SSD) together with a lower cheek and neck flap for coverage of a large cheek skin defect

A method of closing a large defect using a skin stretching device is presented. This was accomplished by moving neck skin cranially without caudal movement of the upper cheek skin or lower eyelid.     

不需植皮的分指设计治疗先天性软组织并指畸形

目的探讨一种不需植皮的分指设计治疗先天性并指的疗效。方法 15例先天性软组织并指患者均采用三叶草状皮瓣成形指蹼、指间锯齿对应皮瓣分开进行分指,创面全部闭合,不需植皮。结果 15例均获随访,时间4-15个月。患儿伤口均一期愈合,无皮缘坏死及感染,外观及功能满意。结论三叶草皮瓣成形指蹼是一种良好的分指设计,临床疗效满意。     

Primary reattachment of avulsed skin flaps with negative pressure wound therapy in degloving injuries of the lower extremity

Large avulsed skin flaps of the lower extremity caused by degloving injuries eventually develop skin necrosis in most cases. The current treatment option involves excision of the degloved skin and reapplication as a full- or split-thickness skin graft. We considered that reattachment of avulsed skin flaps without excision would be theoretically beneficial, since some circulation may remain around the connected pedicle and thus facilitate graft take. Furthermore, securing the skin to the original anatomic position is much easier using retained landmarks. We treated a total of 12 patients (13 cases) with degloving injuries of the lower extremity. In all cases, the avulsed skin flap was defatted and sewn back to the original position, then negative-pressure wound therapy was applied over those grafts as a bolster for approximately 7 days. Most of the avulsed skin flap took excellently, particularly close to the connected pedicle. Nine cases did not need any additional surgical procedures. Four cases required secondary skin graft for a small area of open wound due to partial necrosis of the defatted skin, as well as the raw surface left by the primary skin defect in the initial operation. Primary reattachment of the avulsed skin flaps without excision is convenient and efficient to cover the open wound over the exposed fascia and periosteum in degloving injuries. This would potentially offer a better alternative to definitive wound closure.     

VSD技术结合全厚皮片植皮修复足背部大面积皮肤软组织缺损

目的探讨应用负压封闭引流（vacuum sealing drainage,VSD）技术结合全厚皮片植皮修复足背部大面积皮肤软组织缺损或毁损的临床效果。方法对10例车祸伤导致的足背部大面积皮肤软组织缺损或毁损者采用先以VSD技术覆盖创面,待肉芽组织生长良好后再以全厚皮片植皮进行修复。结果10例患者足部创面愈合良好,足部植皮一期成活,植皮无破溃,无瘢痕挛缩,足部外形不臃肿,是部功能无明显影响。结论该手术方法操作简单,风险低,术后护理方便,植皮区不需二期整形,不影响足部功能,是修复足背部皮肤软组织缺损的理想方法。     

Management of large skin defects in newborn children with myelodysplasia: a new method

A method successfully used in closing a large skin defect in each of three children with myelodysplasia is described in detail. Full thickness skin closure was achieved in 7--10 days without skin grafts or rotation flaps.     

Immunological investigations of antigenicity and specificity of soluble collagen fractions. IV. Anaphylaxis and allergy experiments.

Collagen prepared from rat, calf, or pig skin was tested on guinea pigs for active cutaneous anaphylaxis. Only one fraction of calf skin collagen gave a slight, positive reaction. No positive reactions were observed in 21 subjects submitted to patch tests and 12 subjects submitted to scratch tests with pig skin collagen. Therefore preparations of pig skin collagen may be used for wound treatment without any risk.     

电凝术微创治疗下肢静脉曲张的临床研究

目的研究和评价电凝术微创治疗下肢大隐静脉曲张的效果。方法采用C型臂下造影确定隐股静脉瓣,在体表做标记,用微创血管穿刺技术结合电凝术对下肢静脉曲张部位进行治疗。结果本组90例患者术后均获得成功,患肢无切口,其中6例出现小腿部皮肤点状电灼伤,3例出现皮下片状硬结,平均住院时间1.5d。结论电凝术微创治疗下肢大隐静脉曲张,操作简便、易行,术后患肢无瘢痕,恢复快,疗效确切,是有效的治疗方法,但须注意适应证的选择。     

Aesthetic closure of the donor site of a radial forearm free flap with two local curved skin grafts

The authors have designed an aesthetic and effective coverage technique using local curved skin grafts along with vascular pedicles without additional skin incisions to solve the disadvantages of skin coverage problem of donor site defect after radial forearm free flap (RFFF) harvesting. This has, to the authors’ knowledge, not been previously described.     

The development of the circle technique for determining the optimum line of tumour excision.

The healing of skin wounds is markedly influenced by their relationship to the tensional forces in the skin. Directional variations in skin extensibility which give rise to the cleavage line phenomenon and the skin tension lines are easily visualized by a recently developed skin marking technique. This technique makes it possible to plan accurately the optimum line of excision of skin tumours, including malignant melanomata, so as to allow primary linear wound closure without the necessity of undermining or grafting. The technique is particularly applicable to the excision of tumours of the back and limbs, and in addition, provides a warning if the local skin tensional state makes primary closure hazardous.     

腋前弧形切口结合环皮片周围打包压迫法预防腋臭术后伤口皮肤坏死

目的:探讨腋前弧形切口结合环皮片周围打包压迫法预防腋臭术后皮肤坏死的临床疗效。方法:采用腋前手术切口,术后环手术区域皮片周围打包加压固定。结果:52例患者中,51例伤口无积液,无裂开,愈合良好。1例患者切口皮肤有点状黑痂,经局部换药后3天痊愈。均获随访1~3个月,无异味,伤口开裂,无瘢痕形成,肢体活动无异常。结论:腋前弧形切口结合环皮片周围打包压迫方法是预防腋臭术后伤口皮肤坏死的一种良好方式,值得临床推广应用。     

Early decrease of skin blood flow in response to locally applied pressure in diabetic subjects

Pressure ulcers are common debilitating complications of diabetes that are caused by tissue ischemia. Skin blood flow in response to locally applied pressure might be impaired in diabetic patients because of the combined effects of a typically low skin temperature and alterations in microcirculatory function, and could be worsened by neuropathy. We measured skin blood flow by laser Doppler flowmetry over the internal anklebone in response to local pressure applied at 5.0 mmHg/min in three groups of diabetic patients (with clinical and subclinical neuropathy and without neuropathy) and in healthy matched control subjects at usual room temperature. Compared with in matched control subjects with comparable skin temperatures (29.3 +/- 0.4 vs. 28.7 +/- 0.4 degrees C), in diabetic patients the skin blood flow response to locally applied pressure was further impeded, even in those without neuropathy. Indeed, skin blood flow decreased significantly from baseline at much lower applied pressure (7.5 mmHg) in diabetic subjects, again even in those without neuropathy, than in control subjects (48.8 mmHg). The large difference between these pressures could partially explain diabetic patients' high risk of developing decubitus and plantar ulcers.     

神经端侧吻合植入失神经皮瓣感觉功能研究

目的 探讨感觉神经端侧吻合后供神经的轴突长入神经移植体后,最终能否形成具有功能的感觉末梢。方法 用新西兰兔15只,将兔一条耳大神经做为供神经,在另侧耳取耳大神经移植体与供神经作端侧吻合后埋入失神经皮瓣,另设正常皮肤组和未植神经作对照组,每组动物5只。4个月后用神经单纤维放电技术观察皮瓣内再生神经纤维放电数量、 分布和类型。结果 对移植神经4个月的皮瓣进行神经电生理检查,见各类敏感纤维放电数量、分布和类型。结果 对移植神经4个月的皮瓣进行神经电生理检查,见各类敏感纤维放电均有出现,放电纤维总数在到正常皮肤经组的58％,而同期末植神经对照组,仅在皮瓣边缘靠近神经的一侧有极少放电。结论 神经端侧吻合方法可以重建皮瓣感觉功能。     

A thrombin ointment that achieves rapid haemostasis of split thickness donor wounds, particularly on the scalp

A procedure is described to achieve rapid haemostasis of split thickness donor wounds by using an ointment containing thrombin (10,000 units mixed in 10 g of petroleum jelly-based gentamicin ointment). The ointment, prepared just before the removal of the skin graft, is immediately spread over the wound after the graft has been taken. With this technique, a steady haemostasis is promptly and simply achieved without the recurrence of bleeding compared to the technique using only a thrombin solution (bleeding time: a mean of 11.5 s for the thrombin ointment and 25.5 s for the thrombin solution, P less than 0.01). Thus, particularly when many skin grafts are needed, further skin grafts from adjacent areas can be readily taken without interference by bleeding. This procedure has proved to be extremely useful in achieving rapid haemostasis of split thickness skin donor wounds, especially when taking skin grafts from the scalp.     

Exogenous transforming growth factor-beta amplifies its own expression and induces scar formation in a model of human fetal skin repair.

OBJECTIVE: Fetal skin wounds heal without scarring. To determine the role of TGF-beta 1 in fetal wound healing, mRNA expression of TGF-beta 1 was analyzed in human fetal and adult skin wounds. METHODS: Human fetal skin transplanted to a subcutaneous location on an adult athymic mouse that was subsequently wounded heals without scar, whereas human adult skin heals with scar formation in that location. In situ hybridization for TGF-beta 1 mRNA expression and species-specific immunohistochemistry for fibroblasts, macrophages, and neutrophils were performed in human adult wounds, fetal wounds, and fetal wounds treated with a TGF-beta 1 slow release disk. RESULTS: Transforming growth factor-beta 1 mRNA expression was induced by wounding adult skin. No TGF-beta 1 mRNA upregulation was detected in human fetal skin after wounding. However, when exogenous TGF-beta 1 was added to human fetal skin, induction of TGF-beta 1 mRNA expression in human fetal fibroblasts occurred, an adult-like inflammatory response was detected, and the skin healed with scar formation. CONCLUSIONS: Transforming growth factor-beta 1 is an important modulator in scar formation. Anti-TGF-beta 1 strategies may promote scarless healing in adult wounds.     

A New Method of Skin Graft Adhesion

An industrially produced fibrinogen-Aprotinin and thrombin-calcium chloride ‘tissue glue’, Tisseel®, has been tested for skin grafting. The ‘take' of the graft was successful in 92% after grafting with Tisseel®, and in 83% without gluing. In difficult areas, such as over mobile muscle or close to skin folds, 88% of cases were successful with tissue gluing and 44% without.     

荷载角质细胞生长因子纳米微囊组织工程皮肤修复裸鼠皮肤缺损

目的 研究荷载角质细胞生长因子(keratinocyte growth factor,KGF)纳米微囊的新型组织工程皮肤对裸鼠皮肤缺损的修复效果及特点.方法 采用超声乳化一溶剂挥发法及低温干燥法,制备KGF纳米微囊,并构建KGF-脱细胞真皮基质(acellular dermal matrix,ADM);分离培养和鉴定人表皮干细胞群和成纤维细胞;接种表皮干细胞群于KGF-ADM之上,观察其生长情况;将荷载KGF纳米微囊的组织工程皮肤移植于裸鼠皮肤缺损处,以无KGF纳米微囊的组织工程皮肤为空白组,以其自体皮肤移植作对照组.于术后2,6周时分别观察修复区组织学愈合及皮片挛缩情况,并应用抗人角蛋白10及β1-整合素免疫荧光检测修复区表皮和真皮层细胞来源、分化及生长情况.结果 表皮干细胞群在KGF-ADM表面生长良好,粘贴紧密,可见到多角形的终末表皮细胞及小圆形的表皮干细胞,活性良好,有连接成片的趋势,部分形成克隆团块.以荷载KGF纳米微囊组织工程皮肤修复裸鼠皮肤缺损,2、6周时修复效果均优于空白组及对照组,移植的组织工程皮肤边缘可与邻近皮肤完全融合,但存在一定的挛缩.镜下可见修复区组织工程皮肤表皮细胞分层良好,与ADM紧密结合,能产生正常角质层.6周时实验组修复区组织工程皮肤切片免疫荧光检测,基底层仍存有少量β1-整合素阳性的表皮干细胞或短暂扩充细胞.结论 所构建的荷载KGF纳米微囊组织工程皮肤修复裸鼠皮肤缺损的效果,优于无KGF纳米微囊的普通组织工程皮肤及裸鼠自体全厚皮片移植修复效果.