Free skin grafting

Our interpretation of fundamental factors involved in free skin grafting have been presented with the aim of extending the usefulness of this simple operative procedure. These fundamental factors involve theoretic and factual considerations of epithelial and secondary tissues.The epithelial and cardiac tissues we believe are the most important fundamental tissues in the body; the epithelial tissues keep us wet animals, the cardiac tissues circulate this wetness. Barring specific disease, these tissues will survive at the expense of all other tissues in order to serve the body and work for body needs until the last remote chance of repair is gone.We make use of the vital characteristics of the type of epithelium we are dealing with, the epidermis (ectodermal epithelium), in determining the time to operate, our operative procedure and postoperative care.The time to perform a free skin graft operation is when the patient can withstand a simple operation; we are not concerned with the ability of the epidermis to survive. It will survive if applied to a suitable base properly and at the expense of the body if need be. Establishing a minimum of body economy as to blood count, hemoglobin, etc., leads to needless delay in free skin grafting. Loss of vital fluid incident to this delay causes degenerative processes in vital organs. The plane of body efficiency is lowered and the patient reverts to the picture of starvation.We classify granulation tissue in the category of free skin grafting as useful, useless and pernicious. It is useful in the first stages of its appearance when the collagenous tissue base is minimal; useless at a later date because a better base can be obtained if the granulation and collagenous tissues are removed; pernicious still later because the healthy appearance of the firm, flat granulations belie the thick layer of strangling collagenous tissue beneath. The reason why the granulations are firm and flat is because the collagenous tissue is at a late stage of maturity, the bed is strong and firm and the capillaries are partly occluded by organizing immature scar.The epidermis has no direct blood supply. It lives on overflowing springs of tissue fluid. This fluid filters through a delicate white fibrous tissue feltwork of the dermis to the epidermis. Our operative procedure is designed to provide optimum conditions for the body to reconstruct from secondary tissue something similar to this fine feltwork which has been lost.For this reason the firm, heavy blanket of secondary tissue found lying on the major supply of necessary nutrition is removed. This allows the body to reconstruct something of secondary tissue, more in keeping with the missing, delicate veil of primary tissue.We believe that success in free skin grafting depends upon the internal fixation of the graft to the host by a physiologic glue, the clot. We do not believe that it depends upon the external pressure of bandages in an attempt to achieve the same result.General, special, local and refrigeration anesthesia are used. As to thermal anesthesia, we follow the method suggested to Dr. Eastman Sheehan and ourselves by Dr. Frederick Allen, i. e., to apply ice bags continuously for two hours prior to operation over the donor site and the area to be skin grafted.We have not been able to sterilize granulating areas surgically by any means other than by their total destruction with a corrosive agent. Since we do not use granulation tissue for skin grafting, its loss is of no moment.Donor sites are unbandaged except for a single layer of gauze which is placed over the wound.Postoperative care, except for general supportive measures, is confined to means of protecting the grafts. A variety of methods may be used.     

Aesthetic strategies for the aging Asian face

Aging that manifests in the Asian face is remarkably different, yet in many ways similar, to that of the white face. These dissimilarities and similarities are highlighted in this article along with overall strategies to approach the aging Asian face. This article focuses almost exclusively on the judgment and thinking that are required when approaching the Asian patient. More specifically, one issue that is covered is the cultural aspect that pertains to patient motivation and perspectives on cosmetic enhancement. The other equally important aspect that is addressed is elaboration of a new paradigm on what constitutes a youthful face, especially as that model relates to the Asian face.     

Aesthetic improvements in mid-lower face skeletal surgery

Current surgical techniques allow to correct congenital and acquired facial deformities as well as aesthetic deficiencies resulting from inadequate bone support with excellent functional and aesthetic results. Hard and overlying soft tissue being in a closer anatomic relationship, remarkable aesthetic improvements can be achieved through the three-dimensional shifting of skeletal sections. Hence, facial aesthetic plays such an increasingly critical role in the repair surgery of basal deformities and in the surgical correction of poor aesthetics associated with growth abnormalities as to possibly trespass plastic surgeons' scope of activity. After setting forth our diagnostic and therapeutic guidelines through some relevant clinical cases, the increasingly closer relation between aesthetics enhancement and purely functional surgery of facial muscular and bone structures will be emphasized. Finally, some of the possible treatments currently available will be outlined.     

Full thickness skin transplantation in the face

Summary Full-thickness skin grafts to the face can take well and result in satisfying function and aesthetic appearance, if certain rules are followed, while planning and performing the transplantation. The observation of the natural aesthetic boundaries of the face, the selection of the donor sites for proper color match, the tension of the skin transplant and the amount of pressure for adaptation are discussed and described in a case report of a young girl with extensive burn scars of the face.The author dedicates the paper to Prof. Dr. Dr. Eduard Schmid, the founder of our Department of Plastic Surgery in Stuttgart, at its 30th anniversary 1979     

Optimizing aesthetic results in skin grafting

The aesthetic goal in skin grafting is to provide a cosmetically pleasing coverage of soft tissue defects while minimizing donor site morbidity. A skin graft should blend well with the color and texture of the surrounding skin, reduce wound size, and not interfere with the function of the reconstructed part. This review examines the key components of choosing the appropriate donor skin for a variety of defects. The decision-making process is based on the anatomic location of the defect; donor site availability; and graft size, thickness, and pigmentation. The aesthetic implications of using a sheet graft versus a meshed graft versus an expanded graft are discussed. Aside from addressing the aesthetic needs of the defect, attention is paid to the functional goals of the reconstructed part and reduced donor site morbidity. Partial graft failure can have significant deleterious effects on the aesthetic outcome of skin grafts. The need for further grafting or healing by secondary intention may result in additional scarring and deformity. Recommendations for improvement in graft take and infection control are presented.     

Aesthetic analysis of Asian skin

Attention to restoring healthy and more youthful facial skin complements facial plastic surgery, optimizing cosmetic results. Asian skin has structural and physiologic differences from white skin. These distinctions account for variations in response to ultraviolet light exposure and alternate clinical manifestations of photoaging. The response to cosmetic treatment modalities also differs in patients of darker skin pigmentation, and this needs to be recognized by the cosmetic and laser surgeon. This article reviews the biology of Asian skin and discusses a clinical approach to aesthetic analysis of Asian skin.     

自体颗粒脂肪移植技术在面部临床应用的进展

目的总结自体颗粒脂肪移植技术在面部的研究与实践,探讨该技术在实际操作中的不同观点。方法查阅近年来国内外有关面部自体颗粒脂肪移植的文献,进行综合分析。结果自体颗粒脂肪移植技术已日趋成熟,应用在面部不仅能调整面部轮廓比例、恢复组织容量,还能改善局部皮肤质地,用于面部填充、面部年轻化等治疗,可获得良好临床效果。目前在供区选择、颗粒脂肪采集方法、纯化处理技术等具体操作方面尚存在争议,但所采取的自体颗粒脂肪移植技术的基本原则一致。结论从循证医学角度来看,自体颗粒脂肪移植技术在面部应用的临床经验很多,但是客观证据不足,有待进一步研究。     

Autologous fat grafting to the lower one-third of the face

Volume loss contributes as much to the aging appearance of the face as sagging and rhytids. This occurs in the nasolabial and labiomental creases, as well as the lips, mandibular ramus, and the prejowl sulcus. Treatment of these areas with autogenous fat has yielded results that are generally good, but often of brief duration. To obtain the best results, trauma to the transplanted adipocytes must be avoided through meticulous attention to the details of technique. Observed complications are usually minor. Despite variability in the duration of effect, the fact that autogenous fat is relatively inexpensive and readily available makes it a viable alternative for facial volume replacement.