A Perifascial Areolar Tissue Graft With Topical Administration of Basic Fibroblast Growth Factor for Treatment of Complex Wounds With Exposed Tendons and/or Bones.

The management of wounds with tendon and/or bone exposure is challenging because of the insufficient blood supply to the wound bed. We describe our experience with 19 patients using a perifascial areolar tissue (PAT) graft with topical administration of basic fibroblast growth factor (bFGF) in the treatment of complex wounds with exposed tendons and/or bones in the extremities. Using a PAT graft is minimally invasive and technically easy, and the donor site is relatively preserved. However, PAT grafts for the treatment of a complex wound with large areas of exposed tendons and/or bones have sometimes failed to survive because of insufficient vascularization of the wound bed. Therefore, topical administration of bFGF, which promotes angiogenesis, was added to the graft. All grafts showed good graft survival and successfully covered the tendons and bones. Topical administration of bFGF accelerated vascularization in the PAT graft and facilitated wound healing by increasing the blood supply to the wound bed and achieved success with the PAT graft. In conclusion, using a PAT graft with topical administration of bFGF is a suitable option for the treatment of complex wounds with a large proportion of exposed tendons and/or bones. With minimal damage to the tissues near the wound, the PAT graft can be a useful option for limb salvage and could become a valuable tool for reconstructive surgeons.

Minced skin grafting for promoting epithelialization of the donor site after split-thickness skin grafting.

It is important to minimize time to healing in the donor site after split-thickness skin grafting (STSG). It has been shown that minced skin grafting improves the appearance of the STSG donor site. The objective of this study was to investigate whether mincing the leftover harvested skin and grafting it back onto the donor site during minced grafting (MG) reduces healing time of the donor site. Normal healing time of the donor site after STSG is 10-20 days; therefore, healing time more than a month is abnormal. Out of the 96 patients (MG: controls=48:48) initially selected for this study, 7 patients (1 in the MG group and 6 in the control group) with abnormal wound healing (healing time >1 month) were excluded because their healing times were too long (from 1.5 to 6 months). All donor sites were on the lateral thigh. A part of the skin was minced and uniformly spread on the entire surface of the donor site. A calcium alginate dressing was applied and covered with a protective gauze dressing. Patients in the control group were treated identically, except that MG was not performed. MG of the STSG donor site reduced the average time to healing by approximately 4days (9.1 vs. 13.2). This effect was independent from the size of the donor site and MG/STSG mass ratio. This procedure, which makes use of skin leftovers after skin grafting, should be performed prior to applying wound covering material as a means of reducing time to healing and level of patient's discomfort.