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The purpose of this study was to identify determinants of split thickness skin graft infection. The bacterial count of the experimental wounds was proportional to the incidence of infection in split thickness skin grafts. When the wound was heavily contaminated with 107 organisms, infection developed under most grafts. Graft take frequently occurred in wounds subjected to a lower level of inoculum. The importance of bacterial counts as a determinant of potential skin graft infection was also suggested by a clinical study. We now routinely use quantitative bacterial counts to identify the granulating wounds that are ready for grafting. The type of organism played no significant role in the development of infection. The recipient site on which the graft was placed had an important bearing on infection of split thickness skin grafts. The incidence of skin graft infection was higher in fascial wounds than in dermal wounds contaminated with the same level of inoculum. Meshing of the split thickness skin graft offered no significant protection against infection. The infection rates of meshed and nonmeshed grafts did not differ significantly in experimental and clinical wounds.

Being rich in vascularization, resistant to infection, and having great capacity for absorbing and repairing, omentum has been used for many years in efforts to repair tissue defects of organs inside or outside of the abdominal cavity, especially for the enhancement of blood supply of ischemic tissues. The introduction of microsurgery has enlarged the scope of omentum transplantation. Since 1978, 30 cases of free omentum transplantation have been done by us, and we report the results here.

The reconstructive surgeon often is called upon to correct a severe deformity after previous operative attempts have failed, leaving a scarred and ischemic surgical field. A successful result requires an innovative operative approach and thorough knowledge of the established principles, as well as willingness to apply and to modify them. Frequently, one is faced with the so-called hypospadias crippled in whom little acceptable genital skin is available for urethral and penile reconstruction. When a salvage procedure is necessary in these instances we have used a free split thickness graft of extragenital skin. This technique was used in 11 male patients between 8 and 21 years old, the majority of whom were seen after multiple failed hypospadias or epispadias repairs. Complications included urethral stricture in 2 boys and fistula in 2 others. Long-term results have been excellent with a followup of 4 years. Although this procedure has not been accepted widely in the past, we believe that it can be useful if several important technical points are observed. This method is a useful addition in a salvage situation for urethral reconstruction when local skin is not available.

Accepting the requirement that there must be intimate contact between a split-thickness skin graft and the underlying periosteum in a vestibuloplasty, a method of forming a stent to meet this.criterion is presented. The procedure uses an overextended impression and a custom-made acrylic resin base. Two methods of modifying the base with a secondary impression to form a stent at the time of the operation are described.

SAM and fine mesh gauze dressings were compared on 60 consecutive skin graft donor sites. SAM dressings are significantly better than fine mesh gauze dressings for healing of split-thickness skin graft donor sites; healing occurs much more rapidly with much less pain. In patients known to be colonized with Pseudomonas, care should be taken when using SAM dressings, although it is not an absolute contraindication. There were no clinically significant differences between Tegaderm and Op-Site.

Due to its high recurrence, genital condyloma acuminata should be widely excised to include the full dermal thickness. Currettage is not advisable, as the rate of recurrence is high. The bigger the lession, the bigger donor area needed to close the defect. The reconstructive options do not merely depend on the defect area, but also on selecting a tissue donor of similar color, thickness, sensation and durability. The ease of donor transfer is equally important. Not many case of giant genital condyloma acuminata wide excision and reconstruction has been reported. For coverage of larger soft tissue defect, skin graft is the most common option; however durability is of concern and the perigenital area is a challenging area to graft. Two cases of perigenital reconstruction after giant genital condyloma excision is reported in this paper, using random perforator based flaps, the double keystone flap. Patient and Method: Both cases of giant genital condyloma underwent wide excision by the urologist and referred to our division for reconstruction. Both patients are male, and the defects were reconstructed using the double keystone flap. One patient needed a split thickness skin graft to cover remaining defect on the penile shaft. Result: In both cases, the double keystone flap successfully covered for the defects on the perigenital with tissue quality similar to its original characteristics. No complication ensued. All flaps were vital, no dehisence nor local infection occurred. Summary: The double keystone flap is a reliable option for the reconstruction of large defects on the perigenital region.

Summary 1.The split thickness skin graft donor sites of 40 patients were sprayed with n-butyl 2-cyanoacrylate (36 patients) and n-heptyl 2-cyanoacrylate (4 patients) as the local treatment to the donor sites. 2.This method of local treatment of the split thickness skin graft donor site when compared with plain fine mesh gauze offered a saving of time of the physician and nurses, allowed for a decreased loss of blood at the time of surgery, especially in patients with prolonged bleeding times, decreased the pain and discomfort to the patient, particularly during the first 48–72 hours post-operatively, did not seem to affect the incidence of wound infection, and required an approximately equal time to heal, Eighty-two per cent. of the patients treated with fine mesh gauze in addition to the cyanoacrylate preferred the cyanoacrylate method of local treatment of split thickness skin graft donor sites. 3.Biopsies were obtained from the healed split thickness skin graft donor sites of 20 (50 per cent.) patients. In 6 of these, cyanoacrylate polymer implants were found in the dermis with the size of the particles ranging from 16 to 160 microns. Because of this and the results of Oppenheimer and co-workers, it is felt that these materials are probably not carcinogenic in humans. However, until such time as they are proven so, or until there is a method to prevent incorporation of implants, or until a more rapidly degradable polymer is developed, their use in elective surgery is not indicated.

Four split thickness skin graft donor sites on the back of each of four minipigs were treated individually with plain fine mesh gauze, fine mesh gauze impregnated with scarlet red, n-butyl 2-cyanoacrylate, and n-heptyl 2-cyanoacrylate. Serial biopsies from each donor site and autopsy tissues were examined histologically and are described. While healing occurred more quickly with the two gauze treatments (both grossly and histologically), the cyanoacrylate reduced the postoperative hemorrhage and was more quickly and easily applied.

Among the current adjunctive treatment modalities available for the treatment of chronic wounds, vacuum-assisted closure therapy showed promising results. However, the VAC Therapy system is expensive, requires extensive amounts of product and needs a power source at all times. In this article, the authors introduce and review their experience with simplest modified vacuum assisted closure (smVAC) for treatment of chronic wound. Three patients with chronic wound came to the plastic surgery division at Sardjito hospital in early 2010 and were treated using simplest modified vacuum assisted closure (smVAC). After the wound bed was ready, split thickness skin graft (STSG) were performed to close the wound and smVAC was used to assist the graft placement. All patients underwent successful healing and reported satisfaction with their results. There were no side effects from using this device, such as maceration, necrosis and bleeding. Through the serial cases, the smVAC had shown to serve its function in providing adequate vacuum pressure for wounds. It is an alternative to the original vacuum assisted closure.

Background: Split thickness skin graft (STSG) is one of the modalities used to close a defect. The donor site can be healed secondarily with tulle grass and moist gauze after 14 days and with transparent dressing will take about 10-13 days. Recently the wound healing by using honey application has been used. Whether or not using honey application with transparent dressing will hasten the epithelialization rate of the STSG donor site is now in question. Method: This research is an open, non-randomized clinical trial with a parallel design and intervention using honey application with transparent dressing. A total of 19 patients (7 female and 8 male) were included in this study. The reapplication of honey was done every two days. The patients was followed up every day, with clinical photograph taken and complaints such as pain, odor and infection noted. Results: The mean epithelialization rate of the donor site treated with honey and transparent dressing was 9,74 (+0,24) days compared to 10,79 (+1,23) days in the transparent-dressing-only group (p=0,00). Conclusion: The application of honey with transparent dressing to cover for STSG donor site led to a faster epithelialization rate, less odor and less pain. Commercial honey was used, and readily available.

IN THE performance of interscapulothoracic amputation of the upper extremity, the sacrifice of a large amount of skin is at times necessary. These large defects pose a problem with regard to the matter of a satisfactory closure. Most surgeons have utilized the split thickness skin graft. Although such grafts are predominately successful, certain disadvantages of this type of closure are obvious. These disadvantages revolve about the following considerations: (1) the placement of a split thickness skin graft on an area which cannot be sufficiently immobilized, (2) the time consumed in preparing the skin, draping, cutting the skin grafts from the donor site and suturing them into the recipient site, (3) the addition of the granulating area of the donor site and (4) the resulting thinness of the thoracic wall covered in this fashion. An injury in this area readily may result in a communication with the thoracic cavity. A recent

Objective: To identify the optimal dressing for split-thickness skin graft (SSG) donor sites. Method: This prospective randomised controlled trial compared two dressings — a new absorbent form of a polyurethane film dressing (Tegaderm Absorbent, 3M) and our standard alginate dressing (Kaltostat, ConvaTec) — on SSG donor sites in 40 patients. Primary outcome measures were: reduced time to full healing; reduced postoperative pain; reduced leakage rates from the dressing. Secondary outcome measures related to acceptability of the dressings to the patient. Results: On removal of the dressings at the first assessment, 79% of the Tegaderm Absorbent donor sites had healed completely, compared with 16% of the Kaltostat ones (pConclusion: Tegaderm Absorbent provides a significant improvement in terms of donor-site pain, healing and ease of management. Declaration of interest: None.

Introduction Obesity and certain medical disorders make the reconstruction of skin defects challenging. Different kind of procedure can be used for these defect, besides, skin grafting is one of the most common and simplest procedure. Fat grafting and stem cells which are located in the adipose tissue have been commonly used in plastic surgery for regeneration and rejuvenation purposes. To decrease graft failure rate we performed nanofat grafting under an autologous split-thickness skin graft in our patient who had a problematic wound. Case description The case of a 35-year-old female patient with a traumatic skin defect on her left anterior crural region is described herein. After subsequent flap reconstruction, the result was disappointing and the defect size was widened. The defect was treated with combined grafting (nanofat grafting under an autologous split-thickness skin graft). At the 6 months follow-up assessment after combined grafting, the integrity of the skin graft was good with excellent pliability. Conclusions Combined grafting for problematic wounds seems to be a useful technique for cases requiring reconstruction. The potential existence of stem cells may be responsible for the successful result in our patient.

Background For children requiring split-thickness skin grafting for burn injury, the optimum donor site dressing is an ongoing subject of debate. The most common dressings in use, both regionally and worldwide, are calcium alginates. We will compare an alginate with two other dressings, all of which are in current use in the Pegg Leditschke Paediatric Burns Centre (PLPBC), to determine which dressing performs the best. Methods/Design This is a randomised, prospective single center parallel three-arm trial comparing three donor site wound (DSW) dressings: Algisite™ M, a calcium alginate dressing; Cuticerin™, a smooth acetate gauze impregnated with water-repellent ointment (petrolatum, paraffin and Eucerite®) and Sorbact®, a gauze mesh coated with a dialkylcarbamoyl chloride (DACC) and amorphous hydrogel. Primary outcomes are days to complete DSW healing, and pain. Previously validated measures will be used for all outcomes. Secondary outcomes are: itch; scar appearance at three, six and 12 months; ease of dressing application and removal and dressing costs and utility. Results will be analysed on an intention-to-treat basis. Donor site thickness will be measured with a small biopsy from the center of the graft, to document the depth of the DSW across the groups. Discussion This study will provide comprehensive short- and long-term data on DSW dressings in pediatric split-thickness skin grafting. The best-performing dressing will become the preferred dressing for the PLPBC. We will provide rigorous data against which other dressings can be compared in future, recognising that alginates are the most common DSW dressing currently in use. Our study design replicates a real-world scenario in order to identify clinically significant differences between the three dressings. Trial registration This trial was prospectively registered on 8 April 2014 with the Australia and New Zealand Clinical Trials Register (identifier: ACTRN12614000380695). Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0557-9) contains supplementary material, which is available to authorized users.

The correction of an ileostomy prolapse by a modification of the technique of skin-grafted ileostomy as originally introduced by Dragstedt and emphasized by Turnbull and Weakley is reported. The operation is simple, safe, and effective, and provides a new dimension for the correction of a heretofore difficult and frustrating problem. A total of four patients have been similarly managed successfully with no recurrences in 1 to 4 years of follow-up.

Eight cases of Hereditary Telangiectasis of the nose were treated surgically by septal dermoplasty. The mucosa of the anterior part of the nasal septum, the floor of the nasal cavity and the inferior turbinate was removed without interference to the perichondrium or periosteum and the denuded area was covered with a split thickness skin graft, taken from the thigh. In all patients the work was done through the nasal speculum and both sides of the nose were operated at one sitting. Bleeding was not severe in all cases but one which was managed by maxillary and ethmoidal ligation. In the follow-up period ranging from 5 months to 6 years only one case of recurrence of bleeding was observed, which was treated again surgically by dermoplasty.

A patient developed bullae in a donor site 3 weeks after a split-thickness skin graft was taken. No reference to blistering in the donor site of a recently taken split-thickness skin graft could be found in the surgical literature, and a computerized search of the world's medical literature revealed only a single report of a similar case. The mechanism of bulla formation has not been elucidated. We alert physicians to this phenomenon and urge that each case that is seen be studied in an orderly manner by histologic, electron microscopic, and immunofluorescent techniques.

In the two cases of congenital absence of the vagina reported herein, the embryologic point of arrest of development of the mullerian ducts was identical. Both patients had a rudimentary uterus, and one had a fibroid tumor on the rudimentary uterus. As a part of operation to construct a vagina in such cases, exploratory pelvic laparotomy appears to be a desirable step in order to determine the status of the internal genital organs. The use of a split thickness skin graft sewn around a vaginal mold and inserted into the dissected vaginal space results in more rapid healing, less scar tissue and a vagina that is soft, pliable and normal in appearance, even to the extent of having rugal folds.

Of 108 women treated for vulvar intraepithelial neoplasia between 1977 and 1984 at the Irvine Medical Center, University of California, and the Memorial Medical Center of Long Beach, Women's Hospital, 48 with multifocal and/or widespread lesions underwent skinning vulvectomy and split thickness skin graft reconstruction. Six women in the skinning vulvectomy sample had early stromal invasion in the vulvectomy specimen. Recurrences at intervals of four to 87 months occurred in 13 patients undergoing this procedure. The risk of recurrence did not appear to be related to the status of the surgical margins because seven of 22 patients with involved margins experienced recurrence compared with six of 26 with uninvolved margins.