Management of skin grafts using negative pressure therapy: the effect of varied pressure on skin graft incorporation.

INTRODUCTION: Optimal pressure settings have been suggested in the use of negative pressure wound therapy (NPWT) in wound dressings. When used as a bolster for skin grafting, an NPWT setting of 125 mm Hg was initially suggested, but not validated through studies. The objective of this study is to report findings on the effect of varied pressure settings on the incorporation of split thickness skin grafts when using an NPWT bolster. METHODS: From 2007 to 2010, 48 inpatients underwent split thickness skin grafting using a negative pressure system as a bolster under the care of 2 surgeons at 2 academic institutions. Twenty-two patients were evaluated retrospectively who were treated using NPWT bolsters at 75 mm Hg and 125 mm Hg based on the surgeon's discretion. Twenty-six patients were evaluated prospectively and were randomized to 50 mm Hg, 75 mm Hg, 100 mm Hg, and 125 mm Hg pressure settings. Graft incorporation was assessed at time of bolster removal, 2 weeks, and 4 weeks, per standard protocol. RESULTS: At each assessment point, incorporation of each skin graft was > 95% in all study subjects, at all pressure settings. CONCLUSION: Whereas initially postulated to be 125 mm Hg, ideal pressure settings for NPWT, when used as a bolster for split thickness skin grafts, may be lower. This study suggests that pressures as low as 50 mm Hg can be tolerated without compromise of skin graft incorporation. Study findings were presented at the Plastic Surgery Research Council Meeting in San Francisco, CA in April of 2010. .

Operative techniques in Asian rhinoplasty.

Rhinoplasty in patients of Asian descent presents a different set of challenges for rhinoplasty surgeons. Most Asian noses are characterized by a thick skin envelope, low radix and dorsum, bulbous tip, weak lower lateral cartilages, and a short columella. In this article, the authors describe an autogenous approach to Asian rhinoplasty that achieves aesthetic results comparable to the use of silicone implants without the associated risks observed with alloplastic implants. The technique consists of the following: (1) harvesting of grafts, (2) an open approach with skin defatting, (3) septal harvest, (4) placement of a septocolumellar graft, (5) nasal tip refinement, (6) radix and dorsal augmentation, (7) osteotomies, (8) alar base modifications, and (9) closure and casting.

Dermabrasion.

This review presents skin anatomy, dermabraders, indications for dermabrasion and microdermabrasion, and dermabrasion techniques for the face, along with potential complications. Dermabrasion is a minimally invasive technique used for skin resurfacing. Its applications include treatment of rhytids, abnormal scarring, and premalignant lesions. The risks of complications are low and include pigment changes, hypertrophic scarring, and infection. Despite the introduction of newer therapies, such as lasers and chemical peels, dermabrasion remains an effective tool for physicians to combat the effects of aging without the downtime required for surgery.

Use of free tissue transfers in head and neck reconstruction.

More than 20 different free flaps have been described for head and neck reconstruction including fibula, iliac crest, scapula, radial forearm, rectus abdominis, anterolateral thigh, latissimus dorsi, and jejunum (Head Neck. 2004;26:930). The high success rate and improved functional outcomes seen with free-tissue transfers have made them the workhorse for oromandibular defects (Plast Reconstr Surg. 2002;110:438; Microsurgery. 2004;24:374). In this article, we outline a few of the commonly used free flaps in head and neck reconstruction.