Long-term results of syndactyly correction: full-thickness versus split-thickness skin grafts

In order to compare the long-term results of full-thickness and split-thickness skin grafts after the correction of congenital syndactyly, 27 patients have been investigated after an average follow-up of 21 years. Post-operative functional and cosmetic results have been assessed by patient records, questionnaires and physical examination. The webs that had received split-thickness grafts showed more flexion and extension lags and the overall spreading of the operated fingers was significantly decreased compared to the control fingers. On the other hand, more re-operations because of web creep had to be performed after full-thickness grafts. Hyperpigmentation and hair growth in the grafts was found in most of the full-thickness grafts, while breakdown of the graft was found in some of the split-thickness grafts. Therefore, based on the results of this study, either full- or split-thickness skin grafts can be used when treating of congenital syndactyly.     

Temporal skin grafts following straight incision for syndactyly correction

For syndactyly correction, combined use of zigzag incision and full-thickness free skin grafts and many modifications have been reported. However, postoperative scars produced by this method on the dorsum and palm are conspicuous, and pigmentation of the grafts can be distressing for patients. In syndactyly correction, not only functional but also esthetic improvement is required. Therefore, we devised a new method, consisting of a straight incision and free skin grafts that are serially excised afterward. The scars after the serial excision are placed on the midlateral lines. Although this method necessitates at least 2 operations, the final scars are minimal, and functionally and cosmetically good results are obtained.     

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.     

The use of split thickness skin grafts in the correction of Apert's syndactyly

Stiffness of the interphalangeal joints of the fingers is a constant feature of Apert's syndrome. Because of this stiffness, the author has used split-thickness skin grafts when correcting Apert's syndactyly, thinking that contraction of such grafts post-operatively would not cause any joint contracture or finger deviation. This paper reports the results of eight patients whose average age at first surgery was 6 months. Separation of all digits was accomplished before the age of 2 years. A dorsal rectangular flap and interposing triangular digital flaps were utilised to create the web space and partially cover the skin defects in the fingers. The remaining digital defects were covered with thin split-thickness skin grafts which took fully in all cases. At final follow-up (1-6 years), the areas covered by skin grafts have reduced in size significantly because of skin graft contraction. However, this did not result joint contracture or digital deviation.     

Pre-auricular full-thickness skin grafts.

The use of the pre-auricular region as a donor site for full-thickness skin grafts is described. It provides a valuable source of skin for the medial canthal-nose, eyelid-cheek areas, providing a good colour and texture match.     

Utilizing full-thickness skin grafts for vaginal reconstruction

Full-thickness skin grafts are superior for certain types of vaginal reconstruction. The advantages of this procedure are decreased contraction, reduced time for postoperative stenting, correction at an earlier age, a lower risk of vaginal stenosis, and improved donor site cosmesis. In addition, the patient has the psychological assurance that she is externally normal as she develops through puberty and adulthood.     

The scalp as a favorable donor site for limited-sized split-thickness skin grafts in comparison to the thigh donor site

We compared the split-thickness skin graft donor sites of hair bearing scalp (n=86) and thigh (n=27) in 113 patients, predominantly adults over a 6-month period. Donor site morbidity (pain, epithelialization, scars) was evaluated, including intensity and duration of pain, number of dressing changes, and duration of epithelialization of the wound. Graft thickness and quality was identical in the two groups. Patients with grafts from the scalp had fewer complaints than those with grafts from the thigh; they also had faster reepithelialization. Costs for staff and material related to the frequency and duration of dressing changes were significantly lower in patients with scalp grafts. The limited size of these grafts must be considered. The scalp as a donor site has the advantage of lower donor site morbidity with minimal pain and fast epithelialization. There was no scarring or alopecia in any of the patients.     

全厚皮片游离移植矫治大面积眼睑分裂痣

目的：探讨全厚皮片游离移植矫治大面积眼睑分裂痣的效果及优势。方法：2002年9月～2006年8月,利用耳后或上臂内侧全厚皮片游离移植矫治大面积眼睑分裂痣6例,男性2例,女性4例,年龄12～28岁;黑痣直径3～6cm。结果：6例患者,2例行耳后皮片移植,4例行上臂内侧皮片移植。所有患者分裂痣完全切除,植皮全部成活。随访3个月～4年,形态、功能良好,无并发症发生,效果满意。结论：全厚皮片游离移植矫治大面积眼睑分裂痣简单易行、适应证广、疗效可靠,是治疗此类疾病比较理想的术式。     

A comparative trial of skin donor site dressings

Summary Skin donor sites dressed with Opsite—an adhesive polyurethane surgical drape, permeable to gases and water vapour only—heal faster and with less pain than those covered with the conventional paraffin gauze dressing. This is largely due to the moist environment which is present under the Opsite drape.