Repair experience of skin necrosis after penile thickening with acellular dermal matrix patch / 中华泌尿外科杂志

A serious complication of penile girth enhancement with acellular dermal matrix(ADM) patch is large area penile skin necrosis. Since the penile skin has characteristics such as thin, elasticity, pliability, and durability to withstand erection and friction, the repair surgery is often difficult to achieve good results. Furthermore, the implantation of ADM patch increases the difficulty of surgery. From March 2014 to August 2019, a total of 13 patients with skin necrosis after penile girth enhancement with ADM patch were treated in our center.The debridement and change dressing, according to the condition of the necrotic skin of penis, were performed in all patients. 7 patients used the repairing method of scrotal skin flap via one side scrotal artery, 6 patients used the repairing method of full thickness skin graft. The penile function was not affected with 6 to 12 months′ follow-up after surgery and the curative effect was satisfactory.

Clinical study of skin grafting in small wounds with anastomotic vascular exposure: report of 16 cases / 中华显微外科杂志

Objective To report the clinical effect of skin grafting in small wounds with exposed vascular anastomosis. Methods From January, 2011 to May, 2018, 16 small wounds with anastomotic vascular exposure were treated by full-thickness skin grafting.Of which, 4 performed after replantation, 9 after reconstruction and 3 after flap transplantation. Thirteen wounds were on hand and 3 in foot. After anastomosing the vessels, 3 arterial anasto鄄moses, 9 venous anastomoses and 4 arterial-and-venous anastomoses were left exposure in wounds.Sizes of artery ex鄄posed in wound were 0.8 to 2.3 mm with an average of 1.0 mm. Sizes of vein exposed in wound were 0.8 to 2.5 mm with an average of 1.2 mm. The areas of soft tissue defect were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm, and the areas of grafted skins were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm. Grafted skin were covered without package nor pressurization. Donor areas were directly sutured.Postoperative follow-up was conducted to observe the postoperative effect. Results Fourteen grafted skin completely survived, one partially survived and healed after immobilization of the limb and change of dressing, and one developed necrosis. All patients were followed-up for 6-24 months (mean 14.4 months). CDU, HHD or CTA were used at the final follow-up. Vascular anastomoses were patency in 15 patients, and 1 patient had embolism developed. No pigmentation was found on the grafted skin. All grafted skin was soft and wearable with two point discrimination at 7-10 mm. The pulse of anastomotic artery could be felt on the grafted skins. Only linear scars were left in the donor sites. Conclusion The operation of full-thickness skin grafting in small wounds with exposed vascular anastomosis was easy to perform and with high survival rate. The effect of operation is satisfactory. The exposure of anastomosed vessels does not affect the patency of anastomotic vessels, and has considerable clinical values.

Clinical study of skin grafting in small wounds with anastomotic vascular exposure: report of 16 cases / 中华显微外科杂志

Objective@#To report the clinical effect of skin grafting in small wounds with exposed vascular anastomosis.@*Methods@#From January, 2011 to May, 2018, 16 small wounds with anastomotic vascular exposure were treated by full-thickness skin grafting. Of which, 4 performed after replantation, 9 after reconstruction and 3 after flap transplantation. Thirteen wounds were on hand and 3 in foot. After anastomosing the vessels, 3 arterial anastomoses, 9 venous anastomoses and 4 arterial-and-venous anastomoses were left exposure in wounds. Sizes of artery exposed in wound were 0.8 to 2.3 mm with an average of 1.0 mm. Sizes of vein exposed in wound were 0.8 to 2.5 mm with an average of 1.2 mm. The areas of soft tissue defect were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm, and the areas of grafted skins were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm. Grafted skin were covered without package nor pressurization. Donor areas were directly sutured. Postoperative follow-up was conducted to observe the postoperative effect.@*Results@#Fourteen grafted skin completely survived, one partially survived and healed after immobilization of the limb and change of dressing, and one developed necrosis. All patients were followed-up for 6-24 months (mean 14.4 months). CDU, HHD or CTA were used at the final follow-up. Vascular anastomoses were patency in 15 patients, and 1 patient had embolism developed. No pigmentation was found on the grafted skin. All grafted skin was soft and wearable with two point discrimination at 7-10 mm. The pulse of anastomotic artery could be felt on the grafted skins. Only linear scars were left in the donor sites.@*Conclusion@#The operation of full-thickness skin grafting in small wounds with exposed vascular anastomosis was easy to perform and with high survival rate. The effect of operation is satisfactory. The exposure of anastomosed vessels does not affect the patency of anastomotic vessels, and has considerable clinical values.

Clinical effect of surgical reconstruction of Ⅱ and Ⅲ degree cicatricial ectropion in 46 patients / 局解手术学杂志

Objective To improve the detail of the surgery for cicatricial ectropion,and the the effect was investigated. Methods Based on 46 patients withⅡ,Ⅲdegree cicatricial ectropion admitted to our department,choose the junction of normal skin and scar tissue as the incision line according to the degree of ectropion and local situation,and to reserve and recover the orbicularis oculi muscle as possible. The released areas exceeded separately the external canthus and reached the level of eye fissure,take advantage of full-thickness skin graft to correct the parallel lines and make fixation to the eyelid ectropion fusion skin graft on external canthal ligament. Results After followed up for 6 months to 2 years,46 cases of eyelid skin grafts survived completely and eyelids were in good reduction,with none case of incomplete eyelid closure. Conclusion Choose the surgical incision and the released areas in a proper way to reserve the structural integrity of orbicu-laris muscle and make skin graft fixation to inner and external canthal skin can prevent effectively the recurrence of ectropion and improve surgical progress.

Negative-Pressure Therapy for Pre-and Post-grafting after Wide Extirpation Excision of Melanoma of the Toe / 대한피부과학회지

Surgical management of acral lentiginous melanoma on the toe poses a difficult challenge because of the lack of surrounding tissue. A full-thickness skin graft after excision may provide a good cosmetic outcome, but graft failure can occur due to limited blood flow of the toe and the thin skin covering over the deep fascia in the pressure bearing area may cause gait disturbance. A negative-pressure device can be beneficial for fixing the graft and stimulating the growth of granulation tissue. A 55-year-old woman diagnosed with malignant melanoma on the right third toe underwent wide excision, after which secondary intention healing was initiated using negative-pressure therapy. When the wound had regenerated enough granulation tissue after 2 weeks, a full-thickness skin graft was performed, which was secured with negative-pressure therapy. The graft was successfully taken after a week thereafter. Accordingly, the use of negative-pressure therapy in the surgical management of acral lentiginous melanoma may be a good option because it facilitates full-thickness skin graft survival in an avascular surface area and aids in the thickening of the pressure bearing area, where acral lentiginous melanoma is likely to occur.

One-sheet spiraling full thickness skin graft for penile resurfacing after paraffinoma excision.

In the midst of on-going non-illicit practice of silicone or paraffin injection to enlarge penis, the author reported 3 cases of surgical treatment to resurface the body of the penis after excision of the destructed penile skin using full thickness skin graft. The skin excision was performed technically through penile body degloving procedure. Full thickness skin graft was then applied as a single sheet donor tissue to cover the denuded penile body spirally. The full thickness graft, which is relatively easy to be performed, is no doubt much thinner than a skin flap, while it also bears a smaller degree of secondary contraction than split skin graft. The color of the skin is considerably matched as it comes from the groin, which is a nearby area of penis. The size and skin sensitization of the penis looks to be natural. The only disadvantage is the common possibility of either spiral or circular junctional scar in between graft edges and between the graft and the penile mucosa and skin to develop hypertrophic scar. However, this possible scar problem applies also to any other surgical scar with any donor tissue. Fortunately, the 3 cases posed no scar problem and normal appearance. All the patients have also regained their normal sexual function.

The Full-thickness Forehead Skin Graft for a Nasal Ala Defect / 대한피부과학회지

Skin cancers require excision and reconstruction for achieving optimal functional and cosmetic results. There are numerous reconstructive options, which include primary repair, secondary intention healing, a local flap and a skin graft. Generally, a full-thickness skin graft is not considered applicable for reconstructing a nasal defect because a local flap is thought to be a superior alternative to a skin graft due to the unique nature of the lower third of the skin, which is often thick and fixed to the adjacent structures. But a defect on a lower third of the nose that includes the nasal ala can be well reconstructed by a skin graft in some cases. The donor site options include the preauricular, postauricular and supraclavicular areas etc. But in some cases, the forehead skin is a good match with the nasal ala area. We herein report the case of a 69-year-old female with a nasal ala defect that was induced by excision of basal cell carcinoma. The patient was reconstructed with a full-thickness skin graft using the redundant skin of the forehead.

Usefulness of a Silicone Wound Contact Layer for Securing a Full Thickness Skin Graft / 대한피부과학회지

BACKGROUND: The tie-over dressing is the classic dressing method for a full thickness skin graft (FTSG) to secure the graft on the skin defect. Although many methods to secure the graft have currently been employed, they have some disadvantages such as stretching discomforts and irregular pressure delivery to the graft, resulting in partial necrosis or surface irregularity. OBJECTIVE: The aim of this study was to evaluate the usefulness of a porous, flexible and distensible silicone wound contact layer (Mepitel(R)) for securing a graft as a bolster fixation in FTSG reconstruction. METHODS: Sixty seven patients with surgical defects following mainly malignant tumor excision were included in this study. After suturing and bolstering the graft in place, a piece of silicone contact layer was used to cover the graft, and then second sutures were placed to apply uniform pressure. RESULTS: Thirty three cases of basal cell carcinoma, 14 cases of malignant melanoma and 10 cases of squamous cell carcinoma were included as a cause of the defects. Forty six defects were located on the head and neck, and the rest were on the trunk and extremities. The size of the surgical defects ranged from 0.5 to 14.0 cm at the greatest diameter (mean: 4.0 cm). One major and 1 minor loss of graft developed. Mild to moderate scar formation, mainly marginal elevation, occurred in 9 patients. Sixty five percents of the patients who had facial defects were satisfied with their results. CONCLUSION: We suggested that a silicone wound contact layer for bolster fixation might be a useful material to secure a FTSG, and this is easy to apply and the resulting cosmesis is good and there are few problems with using it.

Usefulness of Full-thickness Skin Graft from Anterolateral Chest wall in the Reconstruction of Facial Defects

PURPOSE: Full thickness skin grafts are useful in the reconstruction of facial skin defects when primary closure is not feasible. Although the supraclavicular area has been considered as the choice of donor site for large facial skin defect, many patients are reluctant to get a neck scar and some patients do not have enough skin to cover the defect owing to the same insult occurred to the neck such as burn accident. We present several cases of reconstruction of facial skin defects by freehand full-thickness skin graft from anterolateral chest wall resulting aesthetically acceptable outcome with lesser donor site morbidity. METHODS: Retrospective review was performed from March, 2007 to September, 2009. 15 patients were treated by this method. Mean age was 31.5 years. The ethiology was congenital melanocytic nevus in 7 cases, capillary malformation in 5 cases and burn scar contracture in 3 cases. Mean area of lesion was measured to 67.3 cm2 preoperatively. The lesion was removed beneath the subcutaneous fatty tissue layer. The graft was not trimmed to be thin except defatting procedure. For the larger size of defect, two pieces of grafts were harvested from both anterolateral chest wall in separation and combined by suture. RESULTS: The mean follow up period was 9.7 months. All the grafts survived without any problem except small necrotic areas in 4 cases, which healed spontaneously under conventional dressings in 6 weeks postoperatively. Color match was relatively excellent. There were 2 cases of hyperpigmentation immediately, but all of them disappeared in a few months. CONCLUSION: In cases of large facial skin defects, the anterolateral chest wall may be a good alternative choice of full-thickness skin graft.

Color Analysis of Forehead Flap and Full Thickness Skin Graft in Facial Reconstruction

PURPOSE: For facial reconstruction, skin color match is crucial to achieve great aesthetic result. Forehead flap and full thickness skin graft have been used for many years to reconstruct facial defect. Their results are aesthetically valuable with remarkable resemblance and harmony of the skin color between donor and recipient sites. The purpose of this study is to evaluate and compare the aesthetic outcome of the two methods as the analysis of skin color match. METHODS: From January 1995 to December 2005, ten forehead flaps and ten full thickness skin grafts were performed. The reconstructed areas of forehead flaps were five noses and five eyelids. Recipient sites of full thickness skin grafts were seven eyelids, two noses and one forehead. In order to obtain the objective validity, the skin color of flap(or graft) and the recipient sites were measured by chromameter. The skin colors were quantified according to a three-dimensional coordinate system used in chromameter, L*(brightness), a*(redness), and b*(yellowness). RESULTS: There was no significant color difference between forehead flap site and adjacent skin in all color values. On the other hand, the L* and b* values of graft sites were significantly lower than those of the adjacent skins. The a* values of graft sites were higher than those of the adjacent skins. CONCLUSION: This study reveals that skin color match of forehead flap is greater than that of full thickness skin graft. As forehead flap has adequate volume and great color match, it can be useful to reconstruct deep facial defect such as nasal defect. On the other hand, full thickness skin graft can be used for superficial defect like partial eyelid defect.

Removal by Mohs Micrographic Surgery and Reconstruction Using Combined Local Flaps / 대한피부과학회지

Xeroderma pigmentosum is a group of dermatoses characterized by autosomal recessive inheritance, photosensitivity, photophobia, early onset freckles, and subsequent cutaneous neoplastic changes on sun-exposed areas. It is due to enzymatic defects that render the cells unable to repair UV-induced DNA damages resulting in various clinical phenotypes. A 66-year-old female patient who has been diagnosed as xeroderma pigmentosum twenty years ago developed a recurrent basal cell carcinoma on the right nasal side-wall, resulting in a large defect that comprises multiple aesthetic units, after a Mohs micrographic surgery. A combination of dorsal nasal and cheek advancement flaps with full thickness skin graft was a useful method for the reconstruction of the large nasal defect.

Removal by Mohs Micrographic Surgery and Reconstruction Using Combined Local Flaps / 대한피부과학회지

Xeroderma pigmentosum is a group of dermatoses characterized by autosomal recessive inheritance, photosensitivity, photophobia, early onset freckles, and subsequent cutaneous neoplastic changes on sun-exposed areas. It is due to enzymatic defects that render the cells unable to repair UV-induced DNA damages resulting in various clinical phenotypes. A 66-year-old female patient who has been diagnosed as xeroderma pigmentosum twenty years ago developed a recurrent basal cell carcinoma on the right nasal side-wall, resulting in a large defect that comprises multiple aesthetic units, after a Mohs micrographic surgery. A combination of dorsal nasal and cheek advancement flaps with full thickness skin graft was a useful method for the reconstruction of the large nasal defect.

Compatibility of Ankle Skin as a Full Thickness Donor Site for Palmar Reconstruction

Although full-thickness skin grafts from the groin donor site are widely used to reconstruct a palmar skin defect, there are many aesthetic and functional problems. To solve the problems, we evaluated the compatibility of ankle skin as a full-thickness donor site for palmar reconstruction. In this study, a grafting method using ankle skin harvested from the just distal area of the lateral malleolus was performed in 17 patients to correct the post-graft contracture of the palm grafted from the groin area. Postoperative course was uneventful except 1 case of donor site disruption. Patient satisfaction rate and color difference rate using color chart manual between the grafts from the groin and ankle were assessed during the follow-up period. The parameters involved color matching, texture matching, durability, mobility, hair growth, hypertrophic marginal scar, donor site scar, patient satisfaction rate, and luminosity, yellowness, and redness in color difference. Most parameters were excellent in the graft from the ankle than that of the groin and significant difference in color was found between the 2 grafts(p < 0.05). The normal skin specimens of the palm, ankle, and groin were examined to compare their histological characters. Ten specimens were taken respectively from both sexes in each site. The skin of the palm and that of the ankle was histologically similar, but it is significantly different from the groin skin, especially in thickness(p < 0.05). Therefore, despite size limitation, the ankle should be considered as a useful option in case of palmar resurfacing of the digits and hand.