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In the treatment of extensive burns, cultured epithelial autograph (CEA) became available commercially in Japan from 2009. Based on the 6 years multicenter surveillance data on using CEA for extensive burns, it is reported that using 6:1 split thickness skin graft together with CEA is successful after wound bed preparation for extensive deep dermal burn or patients with deep burn [1].

Background: Dressing of split-thickness skin graft donor sites can be traumatic for the patient. The most advanced and expensive dressings have been compared to the most basic of dressings, with little or no consensus and an unpersuasive level of evidence. We aimed to determine the efficacy of the locally manufactured non-adherent, hydroconductive Drawtex® dressing and compare it to our current standard-of-care dressing, a thin transparent polyurethane film, in the healing of split-thickness donor sites. Methods: This prospective, within-patient controlled study included 27 adult participants, each with two split-thickness skin donor sites. The 54 donor site wounds were compared with regard to time to re-epithelialisation, perceived pain and healed wound quality. Results: By day 5, complete healing of donor site wounds, defined as >90% of epithelialized surface, was significantly higher in the hydroconductive dressing group compared to the polyurethane film group (22.2% and 3.7%, respectively; p < 0.0001). The hydroconductive dressing-treated donor site wounds were significantly less painful at 24-hours, 48-hours and 7-days post-operatively, and had fewer complications and superior wound healing quality. Conclusion: We have demonstrated that the relatively cheap and readily available dressing made locally in South Africa, Drawtex® is at least as safe, and potentially superior in wound healing, when compared to our current standard-of-care dressing.

Background: Managing the donor site after harvesting a skin graft is a chief issue. There are various dressings available for the management of donor sites but there has not been a widely accepted method for these partial thickness grafts. Honey has been found to be useful in the treatment of wounds like burns for thousands of years, but only in recent times that a scientific explanation is available for its effectiveness. Split-thickness skin graft donor sites are comparable to partial thickness burn wounds.Methods: In this study, the effect of honey on skin graft donor sites has been evaluated. 50 patients have undergone skin grafting for various reasons have been randomized into two groups of 25 each in honey-treated group and Vaseline gauze-treated group. In the group A, who were treated with honey, 85% of the patients had nil or only moderate pain, whereas in the group B, who were treated with Vaseline gauze, 80 % had nil or mild pain. On examining the donor site on the 7th day, epithelialization has occurred in 48 patients as compared to 39 in group B. By the 10th day, all the wounds healed in group A who were treated with honey, whereas 66 % of wounds healed in Vaseline gauze-treated group. At 1-month follow-up, the results were comparable in both groups, with regard to patient satisfaction.Conclusion: Honey-impregnated gauze reduces pain and heals donor sites wounds quicker with better cosmetic result.

The development of squamous cell carcinoma in sites of split skin graft harvest is a rare complication with only 12 documented cases in the literature. The growth of squamous cell carcinoma after arterial puncture is a rarer phenomenon, with no previous cases documented. This series describes two cases. The first case is of a 70-year-old male who developed rapidly growing squamous cell carcinoma in a graft donor site, 9 weeks after split skin graft repair of pretibial squamous cell carcinoma excision. The second case is of an 84-year-old male who developed a large exophytic squamous cell carcinoma in the right wrist that developed 5 months after radial artery puncture. This case series explores the various mechanisms of de-novo squamous cell carcinoma development in areas of cutaneous surgical intervention, including graft harvest. It also provides recommendations regarding the necessary precautions to avoid implantation of squamous cell carcinoma into distant sites. Lastly it highlights the importance of surveillance for any suspicious lesions arising from areas of previous cutaneous surgical intervention.

Objectives Necrotizing fasciitis of the head and neck region is a rare but lethal complication of any head and neck infection. We present a case of cervical necrotizing fasciitis secondary to peritonsillar abscess requiring a large neck debridement and bilateral mastectomies that was treated in our institution. Case report A 38-year-old male presented with a history of sore throat which progressed to right neck swelling and bilateral chest pain. Blood work was only significant for a white blood cell count of 22.0 × 10 3 /μL. Computed tomographic imaging of the neck and chest demonstrated a right peritonsillar abscess involving the right masticator space and carotid space which had dissected laterally and superficially to involve the right sternocleidomastoid and bilateral pectoralis muscles. The patient was taken emergently to the operating room for wide excision resulting in a neck debridement, right total mastectomy, and left partial mastectomy. After multiple debridements, intravenous antibiotics, and dressing changes the patient underwent split thickness skin grafting to his neck and chest wounds and was subsequently discharged from the hospital 45 days after initial presentation. Conclusions Necrotizing fasciitis of the head and neck demands a high index of suspicion involving a multidisciplinary team, rapid diagnostic measures and aggressive surgical and antibiotic management as the mainstay of treatment in reversing this potentially fulminant and lethal disease process. In this rare case of peritonsillar abscess resulting in cervical necrotizing fasciitis, the infection spread across cervical fascial planes onto the anterior chest wall rather than dissecting as usual to the parapharyngeal, retropharyngeal spaces or mediastinum. Extensive and potentially disfiguring debridements may be necessary to obtain negative margins with frequent reoperations until the patient is ready for reconstruction.

Introduction The optimal therapy for deep burn wounds is based on the principle of rapid necrectomy and coverage in order to achieve healing that is as scar-free as possible. The available infrastructure and the patient’s condition represent limitations. With enzymatic debridement, selective bedside debridement can now be performed, however the optimal cover after enzymatic debridement has not been elucidated to date. In this study we compare superficial dermal and deep dermal wounds, which are either covered with lactic acid membrane, piscine skin, or split-thickness skin graft. To validate our approach the healed burn wounds were examined for objective (elasticity, water content, sebum, wound healing) and subjective skin quality as part of our standard follow-up care. Methods In this study, 12 patients who had received piscine skin, lactic acid membrane, or split-thickness skin graft after enzymatic debridement were retrospectively examined objectively and subjectively for scar quality as part of follow-up care 12 months after the accident. The wound healing process was also documented. Results Acceleration of wound healing was observed with the application of piscine skin vs split-thickness skin graft or lactic acid membrane. Skin elasticity was comparable to that of split-thickness skin graft but significantly better than lactic acid membrane. The sebum production in wounds treated with piscine skin was higher compared to lactic acid membrane covered wounds. The water storage capacity in the piscine skin treated wounds was also significantly higher than in lactic acid membrane or split-thickness skin graft treated wounds. Using the POSAS score, an improvement in elasticity, thickness, pigmentation, and relief was shown in piscine skin treated wounds, as well as a reduction in pain and itching, compared to split-thickness skin graft or lactic acid membrane. Conclusions The use of intact piscine skin immediately following enzymatic debridement in burn wounds results in faster wound healing and better patient outcomes compared to split-thickness skin graft or lactic acid membrane.

Highlights: • Repeated pelvic surgery in irradiated tissue increases the risk for vaginal rupture. • We present a rare case with heavy secretion from the ruptured vagina. • Split skin grafting was used as an unusual treatment for this complication.

Background: applying split thickness graft (STSG) is as one of the reconstruction techniques and it is often conducted. Applying the technique creates superficial wound on the donor wound or it is known by donor site. The elastic bandage usage is one of the tools which is used in giving treatment to donor site as a standard operational procedure treatment at Dr. Moewardi hospital (RSDM) Surakarta. RSDM Surakarta has not had clinic test yet to compare between applying elastic bandage Leukocrepe® and Medicrepe® on wound care STSG on the thigh area. Subject and Method : The study used post-test only control group design with the total of the sample was 18 patients. The study was conducted in intermediate STSG donor wound with 0.018 inches thickness on the lateral thighs. By dividing two donor wounds, a half-sided of upper part was bandaged by applying Leukocrepe® and the other half of the lower part was bandaged by Medicrepe®. After that, epithelialization score was conducted on the seventh day. All the data then were collected and after that the data were tested by applying Wilcoxon rank test. Result: according to the study conducted to 18 patients of plastic surgery section at RSUD Dr. Moewardi during November 2016-Juni 2017, the result showed that the epithelialization chart was approximately 61.39 ± 30.05% for STSG donor wound on the lateral thighs part and it was done on the seventh day by applying Leukocrepe, meanwhile applying Medicrepe, the result was approximately 43.67 ± 30.69 %. The mean score of epithelialization applying Medicrepe® was more significant than applying Leukocrepe® and it showed that there was significantly different statistically with the score (p

Background A prospective, randomized, placebo-controlled clinical trial was conducted to compare the healing effectiveness of Alkanna tinctoria (L.) Tausch (Boraginaceae) with standard dressing on wound healing at the donor site after removal of the skin graft. Methods Enrolled patients were randomly allocated to receive topicalA. tinctoria extract ointment (20%) or standard dressing (dressing with base ointment) daily. Wound healing was assessed using the Bates-Jenson assessment tool at the 2nd and 4th weeks after intervention. Results Decreases in wound score were significantly greater in the A. tinctoria group compared with the placebo group (P

Introduction Skin graft meshing is frequently used to allow coverage of extensive wound areas, reduction of donor site size, and prevention of fluid accumulation underneath the skin graft. Meshers allow for various ratios to be used but no studies have confirmed the accuracy of the mesh ratio provided by the manufacturers. The objective of this study was to measure the true mesh ratio achieved using some of the most commonly used skin meshers. Methods A prospective cohort study was performed in 2019. The true expansion ratio was calculated for standardized human split-thickness skin grafts (4x4cm harvested 0.0012in depth using an air dermatome) of the most commonly used meshing ratios (1:1, 1:5:1, 2:1, 3:1, 4:1, and 6:1). Results We had a total of 18 patients resulting in 86 measurements. The study population consisted of 12 males and 6 females; 89% white, 11% non-white; average age of 43 years (SD 21.2). The true mesh ratios of 1:1, 1.5:1, 2:1, 3:1, 4:1, and 6:1 meshers were found to be 1.20 (SD 0.14), 1.55 (SD 0.32), 1.68 (SD 0.32), 2.62 (SD 0.51), 2.87 (SD 0.92), 4.94 (SD 1.35), respectively. The percent errors were 20.2%, 3.3%, -15.8%, -12.5%, -28.3%, -17.7% respectively. Conclusions Mesh ratios of 2:1 meshers and above established by manufacturers are inaccurate. Therefore, overestimation of 2:1 meshers and above is recommended. We recommend an overestimation of 10% or more for meshers 2:1 and above. Applicability of Research to Practice This has significant applicability to practice as it can affect surgical decisions related to estimating the extent of donor area needed to cover skin and soft tissue defects.

Split‐thickness skin grafting (STSG) is a widely used method in reconstructive surgery, but donor site wounds (DSWs) are often slow healing and painful. This prospective study evaluated the performance of a composite wound dressing containing collagen/oxidised regenerated cellulose in the treatment of medium‐depth (0·4 mm) DSWs in 25 multi‐morbid patients with chronic leg ulcers requiring STSG. The range of patients' ages was 44–84 years (mean 71·6 years) with DSW sizes ranging between 12 and 162 cm(2) (mean 78 cm(2)). Comorbidities included anticoagulation therapy (15 patients), anaemia (11 patients), diabetes (6 patients) and methicillin‐resistant Staphylococcus aureus (MRSA) ulcer colonisation (6 patients). The first dressing change was performed after 10 days. Complete reepithelialisation was observed between the 10th and 34th day (mean 17·2, median 14 days). Postoperative medium to strong bleeding occurred in only five patients (four with anticoagulation). Wound pain levels one day after harvesting were only moderate (range 0–1·5, mean 0·5, median 0·5 on a six‐item scale). No wound infection was observed during the first dressing. The composite dressing used allowed for the fast healing of medium‐depth DSWs with minimal or no postoperative pain and bleeding in older multi‐morbid patients under anticoagulation treatment.

Background Although new therapeutic approaches for burn treatment have made progress, there is still need for better methods to enhance wound healing and recovery especially in severely burned patients. Nanofibrillar cellulose (NFC) has gained attention due to its renewable nature, good biocompatibility and excellent physical properties that are of importance for a range of applications in pharmaceutical and biomedical fields. In the present study, we investigated the potential of a wood based NFC wound dressing in a clinical trial on burn patients. Previously, we have investigated NFC as a topical functionalized wound dressing that contributes to improve wound healing in mice. Methods Wood based NFC wound dressing was tested in split-thickness skin graft donor site treatment for nine burn patients in clinical trials at Helsinki Burn Centre. NFC dressing was applied to split thickness skin graft donor sites. The dressing gradually dehydrated and attached to donor site during the first days. During the clinical trials, physical and mechanical properties of NFC wound dressing were optimized by changing its composition. From patient 5 forward, NFC dressing was compared to commercial lactocapromer dressing, Suprathel® (PMI Polymedics, Germany). Results Epithelialization of the NFC dressing-covered donor site was faster in comparison to Suprathel®. Healthy epithelialized skin was revealed under the detached NFC dressing. NFC dressing self-detached after 11–21 days for patients 1–9, while Suprathel® self-detached after 16–28 days for patients 5–9. In comparison studies with patients 5–9, NFC dressing self-detached on average 4 days earlier compared with Suprathel®. Lower NFC content in the material was evaluated to influence the enhanced pliability of the dressing and attachment to the wound bed. No allergic reaction or inflammatory response to NFC was observed. NFC dressing did not cause more pain for patients than the traditional methods to treat the skin graft donor sites. Conclusion Based on the preliminary clinical data, NFC dressing seems to be promising for skin graft donor site treatment since it is biocompatible, attaches easily to wound bed, and remains in place until donor site has renewed. It also detaches from the epithelialized skin by itself.

Donor-site wound healing was tested with a silver sulfadiazine (SSD)-impregnated hydrocolloid dressing and hydrocolloid dressing applied manually by a physician on site. A total of 14 patients, 5 woman and 9 men (23-89 years old, average = 61.6 ± 18.70 years), were enrolled in this prospective controlled study. The degree of bleeding was significantly less with the SSD-impregnated than with the hydrocolloid dressing (P < .01). In the moisture meter analysis, the values of the effective contact coefficient and corneal thickness were significantly smaller with the SSD-impregnated dressing (P < .05). In the color analysis, the clarity was significantly lower with the hydrocolloid dressing after 3 months than that of intact neighboring skin (P < .01). Regarding red-green color, SSD-impregnated and hydrocolloid values were significantly greater than the intact skin value immediately after and at 3 months, and the hydrocolloid value was significantly greater than intact at 6 months (P < .01 immediately; P < .01 at 3 months and intact at 6 months) in redness. Regarding yellow-blue color, the hydrocolloid value was significantly lower than the intact skin value at 3 months (P < .05 and intact) in yellow. The extensibility was significantly lower with the hydrocolloid dressing than in intact skin immediately (P < .01), and viscoelasticity was significantly lower with the hydrocolloid dressing than in intact skin immediately and after 3 and 6 months (P < .01 immediately and at 6 months and P < .05 at 3 months). The SSD-impregnated hydrocolloid dressing led to superior wound healing, decreased the degree of bleeding, and demonstrated better corneal barrier function, clarity, color matching, and viscoelasticity in split-thickness donors.

Despite early management of hand burns, split thickness skin graft has its limitations. This is a case of a previously treated hand burn which was reconstructed with Integra when patient was unable to flex from MCPj due to tightness of the scars.

Purpose To determine the current postoperative mobilization care practice patterns of burn surgeons after split-thickness skin grafting and to assess potential inconsistencies in management strategies. Methods A cross-sectional study of active burn surgeons was conducted with an online questionnaire (SurveyMonkey) comprising 7 demographic and 22 mobilization-related questions. Results Seventy-three (22%) of the 337 members of the American Burn Association mailing list consented to participate in the study, of whom 71 completed the demographic questions and 59 completed the mobilization-related questions. The majority of respondents had more than 10 years of burn care experience (68%) and practiced in an American Burn Association-verified center (70%). Standardized postoperative autograft mobilization protocols were used by 68% of respondents. Most (66%) never or rarely immobilized the upper extremity without joint involvement. When the elbow or wrist was involved, 73% always or very often immobilized. Similarly, 63% never or rarely immobilized the lower extremity without joint involvement. Most immobilized when the knee (70%) or ankle (63%) was involved. Immobilization duration was most commonly 3 or 5 days. Most respondents (71%) reported following Nedelec and colleagues' recommendation that "early postoperative ambulation protocol should be initiated immediately after lower extremity grafting," although there was practice variability. Conclusions Our findings reveal that the majority of survey respondents do not immobilize the extremities after autograft without joint involvement. When grafts cross major joints, most surgeons immobilize for 3 or 5 days. Despite some practice variability, surveyed burn surgeons' current lower extremity ambulation practices generally align with the 2012 guidelines of Nedelec et al.

Exposure of a renal transplant through the abdominal wall is a rare event. A search of the literature reveals only six documented cases which used skin autograft for coverage, with none reported since 1981, and none which used negative-pressure wound therapy (NPWT) to prepare the recipient bed. This case report demonstrates that NPWT followed by split thickness skin graft is a reconstructive option which is feasible in patients who are at high risk for surgical complications in prolonged flap surgery.

The case report discusses split thickness skin grafting in a patient with active psoriasis. This also reports a case of a rare variant of squamous cell carcinoma.

Background Harvesting a split thickness skin graft is one of many distinctive technical skills the training plastic surgeon is required to hone. Historically harvested via a manual dermatome (i.e. Humby’s knife), nowadays commonly forsaken in favor of the electric dermatome. We present a low-cost, easily available teaching method, favored in our department for practicing the use of Humby’s knife, and instructing novice surgeons. Methods 15 plastic surgeons comprising 8 seniors and 7 residents, in a single tertiary center participated. Each used a Humby knife to mimic harvesting 4 skin grafts from a Pomelo. The grafts obtained were analyzed via image processing software and compared across sequential attempts per person as well as across groups of surgeons. Results In the resident surgeon group, the average delta between target and harvested graft areas was 0.45, as compared with 0.15 in the Senior surgeon group, indicating lesser consistency of graft harvest in the resident group. Comparisons across groups yielded significant differences per each of the 4 grafts harvested (p Conclusions Citrus fruit may provide a useful substrate to instruct and practice the use of Humby’s knife. The larger the fruit - the more convenient a model it serves, the Pomelo making an easy choice where available (otherwise large grapefruits or even oranges will suffice). Novice surgeons may greatly benefit from learning and practicing this procedure in a safe setting, and when traditional models (i.e. cadaver labs) aren’t readily available (e.g for financial or ethical reasons) - this simple substitute may prove invaluable.

Split thickness skin graft (STSG) is a versatile procedure performed for the treatment of wounds resulting from varying pathology. This remains very useful because of its ability for quick healing and low complication rate. The surface of the foot and ankle is an area frequently affected by severe skin and soft tissue structure infections (SSTIs) whose treatment results in wounds. These infections and resultant surgical wounds are commonly seen patients with diabetes. The objective of the present study was to retrospectively evaluate initial healing and immediate post-operative outcomes following STSG application in a diabetic population when negative pressure wound therapy (NPWT) was used as a bolster. Ten patients were identified, including 11 surgical wounds, who underwent STSG bolstered with NPWT from January 2016 to October 2018. Mean follow-up was 13 months (range 1-33 months) with an average time to heal of 17 days (range 14-30 days) for 11 surgical wounds averaging 57 cm2 (range 6.3 - 91 cm2). Consistent improved outcomes have been demonstrated when compared to alternative bolstering techniques available in the literature making a STSG bolstered with NPWT a powerful tool in the reconstruction of diabetic foot wounds resulting from the treatment of infection. Levels of Evidence: Level IV

A retrospective review was done for each wound (n = 223) in all patients (n = 191) who underwent Split Thickness Skin Graft (STSG) placement in the Wound Division at Georgetown University Hospital from January 2014 to March 2017 in order to determine the factors that significantly affect STSG take. In doing so, these factors that prove to significantly affect STSG take can be used to predict the possibility of graft failure, and, thus, determine if additional measures must be taken in order to improve the success of the skin graft. Patient medical records were examined for patient demographics, comorbidities, wound parameters, wound bed prep, post-operative dressing, 30 day graft outcomes, and 60 day graft outcomes. Statistical analysis was performed to determine the significance of each factor, and further analysis was done to determine the association and risk of the statistically significant factors. Statistical analysis showed a significant association between Negative Pressure Wound Therapy (NPWT) for wound bed dressing after STSG placement and successful STSG outcome compared to use of bolster only for the post-surgical wound (χ2 = 4.66, p=0.0308). The odds of STSG failure in patients who underwent NPWT were approximately 80% less than those who had bolster dressing used for their post-surgical dressing (OR = 0.203). These results indicate that NPWT after skin graft placement yields a greater success rate for split-thickness skin grafts than conventional bolster dressing. In terms of comorbidities, there was also a significant association between congestive heart failure (CHF) and STSG failure (χ2 = 4.12, p=0.0422). Patients with CHF were approximately 2.55 times more likely to have their STSG fail (OR = 2.55), indicating that CHF is a good predictor of split-thickness skin graft failure. It was also found that bacterial presence and STSG failure also showed an association (χ2 = 4.66, p=0.0308), in which patients with bacterial presence on the wound prior to debridement were approximately 2.89 times more likely to have STSG failure (OR = 2.89). Although bacterial presence prior to debridement showed an association with STSG failure, bacterial presence after debridement just prior to STSG placement did not show a significant correlation with STSG failure [nf = 52 (73.2%) versus ns = 95 (62.5%), (p = 0.1150)]. These results suggest that bacterial presence may also be a good predictor of graft failure, however it is possibly the strain of bacteria, not the presence of bacteria that predominantly affects skin graft take. In order to elucidate the role that bacteria plays in the success of STSG take, further experimental analysis is warranted.

Background Donor site complications secondary to radial forearm free flap (RFFF) reconstruction can limit recovery. Optimizing hand and wrist function in the post-operative period may allow more efficient self-care and return to activities of daily living. Negative pressure wound dressings (NPD) may increase blood flow and perfusion as compared to static pressure dressings (SPD) designed to minimize shear forces during the healing period. This study aims to compare subjective and objective hand and wrist functional outcomes following RFFF reconstruction with split thickness skin grafts (STSG) in patients treated with NPD and SPD. Methods Adult patients undergoing RFFF with STSG were identified preoperatively and randomized to receive NPD or SPD following their RFFF reconstruction. NPD involved a single-use, portable device capable of applying 80 mmHg of negative pressure to the forearm donor site. SPD involved a volar splint. Dressings were left in place for seven days with subjective and objective function assessed at seven days, one month and three months postoperatively. The primary outcome was self-reported hand function as measured with the function subscale of the Michigan Hand Questionnaire (MHQ). Secondary outcomes included hand and wrist strength, range of motion, sensation, scar aesthetics, and skin graft complications. Results Twenty-four patients undergoing RFFF were randomized to NPD or SPD. Patients treated with NPD had improved MHQ self-reported functional scores as compared to those treated with SPD at seven days postoperatively (P = 0.016). Flexion at seven days was improved in NPD group (P = 0.031); however, all other strength and range of motion outcomes were similar between groups. There were no differences in rates of graft complications, scar aesthetics, or sensation. Conclusions In the immediate post-operative period, NPD was associated with improved patient-reported hand and wrist function. Wound care to optimize hand and wrist function could allow for improved patient outcomes in the immediate postoperative period.

Background Necrotizing fasciitis (NF) is a rapid infectious process involving the fascia and subcutaneous tissue. Current standards of care rely on surgical debridement, resulting in large defects, with limited reconstructive options. Wound management has evolved over the last decade, including use of bilayer wound matrices (BWM). The authors sought to assess the use of collagen-GAG bilayer wound matrices on STSG take for NF wounds. Methods A qualitative clinical evaluation (2016–2018) was performed to analyze the efficacy of BWM to aide in STSG take. Primary outcomes were 180-day bilayer matrix success, defined by progressing to split-thickness skin graft (STSG) and STSG take, determined by clinical evaluation. Wounds without a diagnosis of NF or reconstruction with BWM were excluded. Results Ten patients with 11 NF wounds were identified. Average BMI was 32 kg/m2. Comorbidities included hypertension (70%), diabetes (40%), and peripheral vascular disease (40%). Average wound size was 542cm 2 (range: 49cm 2 -1050cm 2 ) and average wound age was 19 days at BWM placement. Matrices were applied to the lower extremity (64%), upper extremity (27%), and perineum (9%). One-hundred percent (n = 11) of wounds were deemed successful by receiving a STSG. Average time to STSG was 44 days (21d –108d). Complications consisted of delayed healing (n = 1, 8%) and partial necrosis (n = 1). No instances of infection or STSG graft loss occurred. Conclusion Complex defects caused by soft tissue necrotizing infections remain a reconstructive challenge. We highlight the benefit of a BWM as a treatment modality for reconstruction by priming the wound bed for a definitive STSG.

Background/aim Skin extension by multiple incisions (SEMI) may be superior to split-thickness skin graft (STSG) for closure of large soft tissue defects. Materials and methods Twenty-six patients who had undergone STSG were compared to 29 patients who had undergone SEMI on the extremities. Patient and Observer Scar Assessment Scale (POSAS), Dermatology Life Quality Index, Wound QoL (Quality of Life) and Short Form Health Survey 36 were used. Elasticity, thickness and skin sensation were compared between the treated and contralateral extremity. Range of motion in adjacent joints was measured. Complication rates were compared. Results A total of 55 patients with a mean follow-up of 5.5 years (range=2-9 years) were examined. Patients with STSG had significantly worse scores in POSAS. The scar was thinner, less elastic and did not provide intact sensibility. Other scores, ROM and complication rates did not differ significantly. Conclusion SEMI was superior to STSG regarding patient satisfaction and scar quality.

Summary Introduction The middle and distal leg coverage is demanding procedure for reconstructive surgeon until evolution of local perforator flaps which becomes as valuable options in lower limb reconstruction. The goal of our study was to assess the results, reliability, safety, and possible complications of the local propeller perforator flaps in lower extremity reconstruction. Patients and methods We demonstrate a case series of 11 patients in whom we cover small-to-medium soft-tissue defects of the middle and distal leg by application of local propeller perforator flaps. Results The site of soft tissue defects were in the distal third in 9 cases (81.8%) and 2 cases (18.1%) in the middle third. Flap dimensions ranged from 48 to 192 cm2, with an average size of 88.9 cm2. The flap rotation was 180 degrees in (63.6%) of cases. The flaps were based on a single perforator of the posterior tibial artery in 8 (72.7%) cases and peroneal artery perforator in 3 (27.2%) cases. Complications were present in 18% of the perforator flaps which were based on peroneal artery perforator, one partial necrosis and one flap with a superfacial epidermolysis. The donor area is covered by split thickness skin graft in 63.6% of our cases and primary closure of in 36.3% of cases. Conclusion The perforator propeller flaps are safe, relatively simple procedure and consider as an ideal option in reconstructing small-medium defects of the middle and distal third of the leg which provide similar skin texture with low donor site morbidity.

A 47-year-old male suffered soft tissue injuries 8 years ago that had been covered by meshed split thickness skin graft. During the last 2 years, he developed a chronic eczema (atopic dermatitis) on both recipient and donor sites on the lower extremities. Eczema on skin graft sites has been described rarely. However, this case is unique since both donor and recipient site were involved. We consider our observation as another example of Ruocco's immunocompromised districts of skin.