Coverage of a 4(th) Degree Contact Burn of Scalp and Calvarium Using a Fasciocutaneous Transposition Flap: A Case Report

Scalp and calvarium defects are caused by trauma, burn, tumor resection, or congenital diseases. We experienced a few cases of severe electrical burn of scalp and calvarium, but fourth-degree contact burn of scalp and calvarium is a rare case. A 67 years old man was presented with a 25% total body surface area contact burn. A 20 cm×15 cm thick eschar on the patient's scalp was observed. Among various techniques for scalp reconstruction, we planned fasciocutaneous transposition flap with split thickness skin graft for coverage of large defect. Considering aesthetically satisfactory outcome, we designed a fasciocutaneous transposition flap including the hair-bearing areas. We additionally used skin graft for uncovered surrounding areas. There were no flap necrosis, graft loss, or any other surgical complications after the surgical flap and skin graft. At 6-month follow-up, the operation site was stable. The patient satisfied with functional and aesthetical outcomes, so we report this case.

Usefulness of Silicone Net Dressing in Fixation of Skin Grafts

PURPOSE: Skin graft may fail for a number of reasons. Hematoma or seroma formation prevents graft adherence. Traditionally tie-over dressing has been used in skin graft fixation, but skin graft in convex and narrow place like fingers or toes, tie-over dressing is hard to be applied. And Vaseline gauze over graft often adheres to graft by exudate into gauze fibers and hardening, and may cause damage to graft in dressing change. We report successful results of using silicone net dressing in fixation of split thickness skin graft over these place. METHODS: After skin graft, the silicone net, Mepitel(R) (Molnlycke Health Care, Box 13080, SE-402 52 Goteborg, Sweden) was applied over the graft followed saline wet gauze dressing in 25 patients. 13 cases were on finger, 8 cases were on foot or toes, 4 cases were on anterior chest. RESULTS: In 22 cases, there were no hematoma or seroma formation, Mepitel(R) maintained 5 days after skin graft. And then, Mepitel(R) was removed from the graft. In 3 cases, there were hematoma formation, Mepitel(R) was removed at 3 days after skin graft. In all cases, grafts were taken well without maceration or skin eruption. CONCLUSION: The silicone net, Mepitel(R), is dressing material made of silicone gel bound to a pliable polyamide net, and it can provide uniform pressure to the graft, even in convex and narrow place. And net like structure allows the exudates of the wound to pass freely into the secondary absorbent dressing and easier to remove from the grafts than Vaseline gauze. We think that the use of a Mepitel(R) is a efficient tool for securing skin grafts.

Coverage of Skin Defect in Deep Second Degree Burn by Using Skin Graft After Advancement Flap

PURPOSE: Skin graft is useful treatment in burn wound. The major disadvantage of traditional skin graft is related to recipient site scarring and donor site morbidity. Then we present our successful experience of using skin graft after advancement flap. METHODS: The study is based on 22 patients who has deep 2nd burn wound with eschar and 3rd degree burn wound. We performed split-thickness skin graft in 17 patients, and fullthickness skin graft in 5 patients. After undermining of wound margin about 1.3 cm~4 cm, we performed suture of wound marginal skin and subcutaneous tissue with absorbable suture materials. Then we harvested skin according to reduced wound size, and we applied donor skin in recipient area. RESULTS: The skin graft area of the 17 patients who had split skin-thickness graft showed a decline of 25% compared with that of the initial burn wound. 5 patents who had full-thickness skin graft also showed a decrease of 10% in the skin graft area compared with that of the initial burn wound. All Grafts were well taken in 22 patients without skin loss. By observing the progress 12 to 15 months after the operation, minor hypertrophic scar on the boundary of grafted skin area was observed in the 2 patents and hypertrophic scar or contracture was not seen in all 22 patients. CONCLUSION: Skin graft after advancement flap can be used as a treatment in deep 2nd degree and 3rd degree burn wound. Compared with traditional skin graft, the result seems to be good cosmetically and functionally.