Hyalomatrix coverage in scalp wounds with exposed cranium and dura.

AIM: The armamentarium of options available for soft tissue reconstruction of the scalp spans the reconstructive ladder. The purpose of this paper is to describe a case series of patients with exposed cranium and dura who were successfully reconstructed using esterified hyalomatrix (eHAM, Hyalomatrix, Medline Industries Inc., US). METHODS: After obtaining Institutional Review Board approval, a retrospective review of the senior author's (ALF) patient database was completed. Patients who underwent scalp reconstruction using eHAM were identified. Each patient's chart was reviewed and data collected on demographics, days to skin graft, duration of follow-up, pathology, comorbidities and complications. RESULTS: This case series consisted of five patients aged ≥18 years, with scalp wounds exposing dura or cranium, who were treated with eHAM as a bridge to definitive coverage with a skin graft. Each wound successfully granulated the exposed critical structure with the use of the eHAM. The mean time to skin graft coverage was 41 days, with a range of 13-79 days. Of the series of five patients, four had a follow-up of ≥12 weeks. The mean defect size was 90.2cm2. CONCLUSION: Complex scalp reconstruction can be accomplished using healing by secondary intention, skin grafts, local flaps, tissue expansion and free tissue transfer. As shown in this case series, another option available in select patients is using a dermal substitute such as eHAM. This is one treatment option available to reconstructive surgeons in multiple specialties.

The safety of pelvic surgery in the morbidly obese with and without combined panniculectomy: a comparison of results.

PURPOSE: The purpose of our study was to evaluate the benefit of panniculectomy combined with pelvic surgery in the morbidly obese patient. Previous literature has found this combined procedure in this particular patient population to have increased morbidity and that it was not beneficial. METHODS: A chart review was performed an all patients who underwent pelvic surgery with or without a panniculectomy between June 2004 and June 2005. Only morbidly obese patients (body mass index of >40 kg/m2) were included in the study. Factors evaluated were operative times, intraoperative blood loss, weight of pannus resection specimen, length of hospital stay, wound infection rate, and other complications. All data were analyzed using Levene test for equality of variances and the t test for the equality of means. RESULTS: Thirty-six patients had combined panniculectomy and abdominal hysterectomy, 14 had an abdominal hysterectomy without a panniculectomy. The mean operative times for the combined procedure was 3.4 hours versus 2.6 hours without panniculectomy. The mean estimated blood loss was 526 mL for the combined procedure (CP) and 536 mL for hysterectomy alone (HA). There were 2 wound infections in the CP group (5.6%) versus 3 in the HA group (21.4%). There was one wound dehiscence in the CP group (2.8%) and one in the HA group (7.1%). There was one inadvertent enterotomy in the HA group (7.1%) and none in the CP group. There were no statistical differences noted for any variable including patient body mass index, mean operative time, estimated blood loss, or rate of complications. CONCLUSIONS: Our findings, in contrast to previous findings, reveal that panniculectomy combined with pelvic surgery in the morbidly obese is a safe procedure that can decrease the incidence of intraoperative complications and postoperative wound complications without significantly increasing operative time or blood loss.