ABSTRACT
Since its first description in 1908, the sternocleidomastoid flap (SCM) has gained popularity in head-and-neck reconstruction as a regional flap. We reported a 69-year-old Caucasian male who was evaluated in our clinic for a large, bloody, esophitic, and ulcerated lesion of the right temporoparotideal region associated with several actinic keratoses of the head skin. After resection of the tumor, taking into consideration the patient's comorbidities and surgical defect characteristics, we decided to use the SCM flap for the reconstruction. The SCM flap was harvested as a muscular flap to avoid as possible skin paddle necrosis due to the poor conditions of the patient's vessels. Moreover, considering the surgical site depth and to prevent a postsurgical excessive scar retraction, the muscle was covered with Integra® Dermal Regeneration Template single layer and a skin graft was harvested from the left thigh. The follow-up at 1 year confirmed that both oncological and reconstructive goals were successfully achieved. In our experience, the SCM flap in association with a dermal regeneration template and a skin graft can be considered as a reliable and possible option in temporal region reconstruction when local or systemic conditions of the patient do not permit other reconstructive options.
ABSTRACT
The postoperative dressing in patients undergoing thigh lift is often difficult, not very resistant to movement, and uncomfortable for the patient, and often exposes surgical site to infection, maceration, or delay in wound healing. METHODS: We included 40 patients in a case-control crossover study with no period effects, who were treated both by Aquacel Surgical and a traditional wound dressing. Surveys with a 10-point scale evaluation were used to assess nontraumatic removal level, ease of application, adhesion, and strength of the 2 treatments. We reported the number of days necessary for wound healing, the number of infection cases, and wound-related complications. Costs of the 2 medications were also considered. Ten days after surgery, patients answered a questionnaire with 6 multiple-choice questions to assess comfort, pain at dressing change, pruritus, strength, and number of dressing changes. RESULTS: Compared with controls, surveys revealed Aquacel Surgical to be less traumatic to remove, easier to apply, and to be more adherent and stronger. Significant acceleration of the wound healing was also evident with Aquacel Surgical compared with the traditional dressing. Nonsignificant differences were reported about the risk of infection and wound-related complications between the 2 treatments. A statistical analysis of costs revealed that Aquacel Surgical is significantly more expensive than the traditional medication. CONCLUSION: We recommend the use of Aquacel Surgical in all the surgery procedures where the risk of wound dehiscence and maceration is high.
ABSTRACT
BACKGROUND/AIM: The closure of postoperative wounds is essential in order to prevent surgical site infections or wound dehiscence, mainly in oncological patients. We aimed to demonstrate the efficacy of autologous micrografts in the management of wound dehiscence in an oncology patient undergoing decompressive spinal laminectomy. CASE REPORT: A 57-year-old man with IgG multiple myeloma and medullary plasmocytoma C7-T3, was to undergo decompressive spinal laminectomy and vertebral fixation leading to a wound dehiscence with exposed instrumentation. Autologous micrografts were obtained by Rigenera protocol and directly applied to the dehisced wound. After 60 days of negative pressure wound therapy, we observed reduction of the diameter and depth of wound dehiscence, with a coverage of instrumentation, without complete re-epithelialization, that instead was reached by application of autologous micrografts after 70 days. CONCLUSION: The Rigenera protocol may be the solution for complex wounds in oncological and immune-compromised patients where other treatments are contraindicated.
