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Injuries Due to Burns and Cold
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
This remains the gold standard for the reconstruction of deep dermal and full-thickness injuries. Early split-skin grafting from the patient’s own unburnt skin (Figure 27.9) creates a partial-thickness skin injury that heals quickly, within 2 weeks, by secondary intention/re-epithelialization. The skin graft is tissue paper thin and, when moved to a debrided burn, the wound gains nutrition initially by diffusion from the wound base and then by ingrowth of blood vessels, which takes between 3 and 5 days.
Resource-Limited Environment Plastic Surgery
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Johann A. Jeevaratnam, Charles Anton Fries, Dimitrios Kanakopoulos, Paul J. H. Drake, Lorraine Harry
Skin grafting is a surgical procedure that involves removing skin from one area of the body and moving it – or transplanting it – to a different area of the body. It is completely detached from its vascular supply and relies on the blood supply of the recipient wound bed to survive.
Biotechnology products and indications II
Published in Ronald P. Evens, Biotechnology, 2020
Cell and tissues therapy products are found in Table 9.5. Surgery, especially gastrointestinal and orthopedic (back) locations, can lead to complications where abnormal connections called adhesions can occur between tissues. They can be persistent and quite painful after surgery and often require a second surgery to eliminate them. Hyaluronic acid products in the form of gels and films are available to prevent them by placement between tissues during surgery. The products are biodegradable in situ to nontoxic substances. Also, tissue damage occurs in various diseases where the tissue is accessible for replacement, for example, skin ulcers from diabetes, or pressure. Skin grafting can be done with exogenously engineered skin products. Repair of wounds and burns can be aided with these grafts. Tissue damage is becoming a greater problem as the population ages, and tissues tend to break down more over time in older populations, for example, osteoarthritis of the knees or facial wrinkling. Knee pain can be relieved and wrinkling reduced with hyaluronic acid products administered directly into tissues, and even chondrocytes can be replaced in the knee. Bone fractures can be mended more rapidly through enhanced processes with biological products or devices that contain bone morphogenic growth proteins (BMPs). Facial lipodystrophy in HIV patients can be reduced with a biological product in a form of lactic acid.
Effect of leukocyte-platelet fibrin-rich wound reconstruction followed by full-thickness skin grafting in the treatment of diabetic foot Wagner grade 4 ulcer gangrene (toe area)
Published in Platelets, 2023
Yuqi Wang, Yanyan Wang, Xiaotao Wang, Yi Zhao, Siyuan Ruan, Hong Cao
Skin grafting is an effective way to treat diabetic foot ulcer wounds, especially wounds with exposed bones and tendons. The course of such wounds is prolonged or even aggravated, and simple skin grafting cannot be used for treatment. Although skin grafting can close the wound as soon as possible, the destruction of the nerve and blood supply makes the possibility of wound recovery very small. Infection, destruction of the blood supply to the wound before transplantation, and loss of the effective part of the soft tissue greatly reduce the probability of the skin survival. Therefore, in this study, leukocyte-platelet fibrin (L-PRF) was used first to treat wounds requiring skin grafts after thorough debridement. The efficacy of L-PRF alone in the treatment of early diabetic foot ulcer wounds has been well established in previous studies. Its active role in controlling infection and improving the microenvironment of the wound is an important condition required to improve the survival rate after skin grafting.
External tissue expansion to salvage failed scalp and forehead reconstruction: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Peter Y. W. Chan, Elina Patel, Ethan Paulin, Ajul Shah
After the failure of the primary reconstructive technique in the forehead and scalp, surgeons are faced with a difficult task. Skin grafting reconstruction may be considered. However, a skin graft requires a vascular bed, and scalp and forehead defects are often denuded without periosteum [9]. Although the bone can be burred to create a foundation of vascularized tissue, the healing process is lengthy and requires regular dressing changes [9]. Additionally, skin grafting in the scalp and forehead is often associated with poor cosmetic results, often leaving a white, patchy appearance [8]. A second tissue-transfer-based reconstruction may be considered; however, these secondary procedures are often even more challenging than the primary technique due to a combination of the first-choice flap already being used, a scarcity of existing vessels to create or receive a new flap, and surgical scarring in the area [5,7,10]. The complication rate of all secondary flap procedures in head and neck reconstruction after initial flap failure has been reported as high as 21–22% [7,13]. Surgeons may also be hesitant to undertake a secondary tissue-transfer-based reconstruction when there was no clear cause of failure in the first.
Management of skin graft donor site in pediatric patients with tumescent technique and AQUACEL® Ag foam dressing
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Split thickness skin grafting is one of the most commonly performed procedures in reconstructive surgery. The skin graft donor site can be managed by a variety of methods [1]. Several types of donor site dressings have been described, each with their own advantages and limitations [2,3]. The ideal dressing should promote epithelialization, minimize pain, prevent infection and be user friendly. AQUACEL® Ag is a sodium carboxymethylcellulose hydrofiber dressing that is impregnated with silver ions [4]. Hydrofibers are materials that absorb fluid and turn into a gel. Silver has antimicrobial properties [5]. A multilayer version of this dressing is called AQUACEL® Ag Foam (Figure 1). The foam layer protects the wound against trauma and absorbs excess exudate. The outer semi-permeable layer is waterproof but allows evaporation of excess exudate. The silicone adhesive layer is easy to apply and is not irritating to the skin. All of these properties make it a favorable dressing for skin graft donor site management.