Management of split-thickness donor sites with synthetic wound dressings: results of a comparative clinical study.

This prospective, randomized, single-blinded, clinical study aimed at evaluating 3 different synthetic wound dressings for treating split-thickness skin graft donor sites. Seventy-seven patients were randomly assigned to 3 study groups: Suprathel, Biatain-Ibu, Mepitel. Wounds were inspected daily until complete reepithelization. Ease of care, treatment costs, and scar development after a 6 months follow-up were evaluated. Suprathel showed significant (P ≤ 0.001) pain reduction after 24 hours but increasing pain scores on the 5th day of treatment. Biatain-Ibu showed significant pain relief immediately after application and during the entire treatment period (P < 0.05). Mepitel did not show any significant pain reduction. No differences were seen with regard to healing time, quality of reepithelization, and scar development. Biatain-Ibu had the lowest overall treatment costs (P ≤ 0.001). The investigated materials did not differ with regard to quality and acceleration of the healing process, but Biatain-Ibu seems to be the most appropriate dressing material in terms of cost-effectiveness.

Free-style local perforator flaps: concept and classification system.

BACKGROUND: Defect reconstruction according to the free-style concept applied to perforator flaps allows flap harvesting in any anatomical region where an audible Doppler signal of a perforator is detected. We report the results of a study in which local perforator flaps were selected for reconstruction in different anatomical areas and were harvested using the free-style concept. METHODS: During a 2-year period, defect coverage was carried out in 21 patients (n=21) in the following anatomical areas: cervical (n=3), sternal/parasternal (n=4), axillary (n=2), tibial (n=5), trochanteric (n=2) and sacral/gluteal (n=5). The mean age of patients (15 male and six female) was 57.8 years. Flap selection was based solely on preoperative Doppler mapping in areas adjacent to soft-tissue defects. The mean follow-up period was 1 year. RESULTS: All flaps survived, demonstrating postoperatively acceptable aesthetic results with good patient satisfaction. The donor sites were closed primarily in 17 patients; four patients required skin grafting. Two patients required surgical revision due to flap-margin dehiscence. There was no loss of function at donor sites. Increased flap mobility could be achieved through extended perforator dissection. One perforator-based flaps offered the widest arc of rotation serving as propeller flaps. If more than one perforator vessel was preserved, flap mobility was limited, but still allowed sufficient flap movement either as a rotation or advancement flap or as a combination of both. A classification is proposed according to the number of perforator vessels preserved and to the type of flap movement. CONCLUSIONS: The concept of free-style local perforator flaps represents a safe, versatile and reliable surgical procedure. It not only offers a greater freedom in flap selection but also provides good aesthetic results. The classification proposed might aid in the decision-making process involved in order to achieve adequate results with this procedure.

Closed-open rhinoplasty with extended lip dissection: a new concept and classification of rhinoplasty.

BACKGROUND: Open rhinoplasty represents a surgical technique that has increased in popularity during the past several decades. However, to achieve full access to the entire nasal framework, a transcolumellar incision is required. In this study, the authors present the results of a rhinoplasty technique avoiding the transcolumellar incision while offering full access to the entire osteocartilaginous framework. METHODS: Twenty-four patients (17 women and seven men) with a mean age of 28.7 years (range, 21 to 49 years) were the subjects of this study. Four patients underwent secondary rhinoplasty and 20 patients underwent primary rhinoplasty. The surgical procedure comprises an alar base resection incision with thorough undermining of the anatomical area between the nasal base and the upper lip, allowing nondistorted access to the entire osteocartilaginous framework and performance of all standard rhinoplasty techniques. A transcolumellar incision is not performed. The minimum follow-up period was 12 months. RESULTS: All 24 patients expressed a high degree of satisfaction with the surgical result achieved. Postoperative swelling and initial lip dysesthesia resolved in all cases within the first 6 weeks without any morphologic or functional sequelae. Considering different rhinoplasty approaches, a classification of the existing surgical procedures is proposed. CONCLUSIONS: The authors believe the rhinoplasty technique presented in this article is a combination of closed and open approaches. It offers excellent access to the entire osteocartilaginous framework, while preserving the columella. The proposed rhinoplasty classification may simplify and aid the surgeon in deciding among the different rhinoplasty techniques.

Suprathel, a new skin substitute, in the management of partial-thickness burn wounds: results of a clinical study.

OBJECTIVE: A prospective, randomized, bicentric, nonblinded, clinical study was conducted to evaluate the impact on wound healing of Suprathel in partial-thickness burn injuries. Suprathel represents an absorbable, synthetic wound dressing with properties of natural epithelium. METHODS: Thirty patients suffering from second-degree burn injuries were included in the study, with a mean of age 40.4 years old. Burn injuries were randomly selected, partly treated with Omiderm and partly treated with Suprathel. The first gauze change was applied the fifth day postoperatively, followed by regular wound inspection until complete reepithelization. The study focused on patient pain score, healing time, analysis of wound bed, ease of care, and treatment costs. RESULTS: There was no significant difference between the 2 materials tested regarding healing time and reepithelization. There was a significant lower pain score for patients treated with Suprathel (P = 0.0072). Suprathel becomes transparent when applied, thus allowing close monitoring of wound healing. In contrast to Omiderm, Suprathel shows better attachment and adherence to wounds. During the course of healing, it detaches smoothly, without damaging the reepithelized wound surface. Moreover, it reduces the frequency of dressing changes required. Ease of care of Suprathel has been rated outstanding by patients and healthcare professionals. When interviewed, patients reported Suprathel as their treatment preference. As dressing material, Omiderm is more cost-effective than Suprathel. CONCLUSION: Suprathel represents a reliable epidermal skin substitute, with a good impact on wound healing and pain reduction in partial-thickness burn injuries. Although it is less cost-effective than Omiderm, the significant increase of patient comfort makes this material represent a reliable and solid treatment alternative when dealing with partial-thickness burn injuries. Further studies with this synthetic dressing on other types of wounds are warranted.

Controlling nasal length with extended spreader grafts: a reliable technique in primary rhinoplasty.

BACKGROUND: The short nose characterized by a reduced distance from the nasal radix to the tip represents a challenging deformity in facial plastic surgery. Several techniques have been described in the literature for augmentation of the short nose, but none emphasizes the surgical maneuvers necessary to preserve nasal length in primary rhinoplasty and to avoid the development of a short nose deformity. METHODS: The authors present a surgical technique for avoiding postoperative nasal shortness and for controlling nasal length in primary rhinoplasty. The procedure uses caudally extended bilateral spreader grafts, which prevent postoperative cephalic tip rotation and allow control of tip rotation. The grafts should be placed electively in noses that have the potential to become overshortened postoperatively. By doing so, surgeons can perform any of the common surgical maneuvers in rhinoplasty without risking short nose deformity. The study included 41 patients with a mean age of 27 years who were considered to be at high risk for the development of postoperative short nose deformity. All the patients were treated with bilateral extended spreader grafts via the open nasal approach. The follow-up period was up to 12 months, with regular evaluation of the surgical outcome comprising measurement of the nasal length and photographic analysis. RESULTS: All the patients showed preserved nasal length after surgery with well-proportioned facial features. There was no evidence of postoperative nasal shortening after 12 months of follow-up evaluation. No operative or postoperative complications were detected. All the patients were pleased with the surgical results achieved. CONCLUSION: The use of extended spreader grafts during primary rhinoplasty for selected patients represents a valuable tool for preventing short nose deformity after primary rhinoplasty.