Full-thickness skin grafts: maximizing graft take using negative pressure dressings to prepare the graft bed.

BACKGROUND: Full thickness skin grafts (FTSGs) remain a good option for resurfacing defects of the face, neck, and dorsum of the feet. It results in soft, pliable, functional skin with minimal contraction. However, FTSG may result in patchy or irregular "take" resulting in recurrent contractures and pigmentary discrepancies. This study examines the use of a negative pressure dressing (NPD) to increase FTSG take. METHODS: Wounds resulting from trauma, postburn contracture release, and an excision of a congenital nevus were included in the study. The wounds were prepared by surgical excision or debridement. A NPD was then applied for a period of 7 days, at which time the wounds were inspected and, if there was sufficient granulation tissue, covered with a FTSG. If the wound had not yet granulated sufficiently another NPD was placed and reassessed in 7 days. The FTSGs were harvested from the groin and abdominal area exactly to the size of the defect. A sponge bolster dressing was then applied. The take of the FTSG was judged using a grid of 1 x 1-cm squares. The wounds were measured and the amount of graft take was calculated as a percentage of the wound size. Complications in both the wound as well as the donor sites were noted. RESULTS: Twenty-four patients were included in the study. The mean age was 6 years (range 1-14 years), including 9 burn contracture excisions, 14 road traffic accident-related injuries, and 1 excision of a congenital nevus. The site involved was the foot (6 patients), ankle (9 patients), axilla (2 patients), forearm (4 patients), face (2 patients), and the neck (1 patient). The average surface area of the defect was 78 cm2 (range 18-264 cm2). Groin skin was harvested in all the cases. The NPD was applied on average for 8 days (range 7-15 days). The mean graft take was 95% (range 70%-100%). Only 1 patient had significant graft loss of 30%. Donor site morbidity was low, attaining primary closure in all but 2. Mean follow-up was 9 months. CONCLUSION: The results of this study confirm that the use of NPD enhances FTSG take.

Choosing the superomedial pedicle for reduction mammaplasty in gigantomastia.

BACKGROUND: The optimal reduction technique for the treatment of macromastia greater than 1 kg remains controversial. Conventionally, breast amputation and free nipple grafting has been used, but this leaves a flat and insensate nipple. Anatomical studies have suggested the superomedial technique to be a safe choice in these patients. METHODS: A retrospective study analyzing the outcome of reduction mammaplasty for macromastia greater than 1 kg using the superomedial pedicle technique was performed. Data were collected over a 10-year period from 1995 to 2005. All reduction mammaplasty patients with resection weights greater than 1 kg per breast were included in the study. RESULTS: Sixty-one patients were included (122 breasts). The mean age was 29 years. The mean suprasternal notch to nipple distance was 35 cm on the left and 35 cm on the right, and the mean nipple to inframammary crease distance was 19 cm on the left and 20 cm on the right. The Wise keyhole reduction pattern technique was used for all patients. Mean follow-up was 12 months. The mean resection weight per breast was 1360 g for the left breast and 1398 g for the right breast. Fifteen different surgeons performed the operations over this period. All patients had viable nipples postoperatively; there was partial areola necrosis in eight breasts (6.5 percent), with only minor other complications, including T-junction breakdown in 22 breasts (18 percent) and dog-ear excisions. CONCLUSIONS: This study has confirmed the superomedial pedicle technique to be safe and reliable for resections greater than 1 kg.

A formula determining resection weights for reduction mammaplasty.

BACKGROUND: Reduction mammaplasty is a frequently performed plastic surgical procedure, yet preoperative assessment usually excludes an estimated resection weight. In this retrospective study, a formula was derived using regression analysis of routinely measured preoperative anthropomorphic measurements and intraoperative resection weights. METHODS: Data were collected from 214 consecutive breast reduction patients operated on at a tertiary referral center between January of 1993 and January of 2006. The operations were performed by 15 plastic surgeons using a variety of reduction pattern techniques. Four variables were recorded for each patient: notch to nipple distance, nipple to inframammary crease distance, body mass index, and age. Regression analysis was performed on the data to establish which preoperative measurements correlated most accurately with the resection weight. RESULTS: The following formula was established relating nipple to inframammary crease distance and notch to nipple distance measurement to the weight removed: Breast weight = (35.4 x notch to nipple distance + 60.66 x nipple to inframammary crease distance) - 1239.64. CONCLUSION: Use of this formula aids the surgeon with patient counseling, insurance company quotes, and intraoperatively in patients with asymmetry or those undergoing reconstruction, as a guide to resection weights.