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Necrotizing fasciitis is a rare but potentially lethal infection of the skin and soft tissue, commonly seen in the perianal and gluteal regions. Concomitant diabetes is a predisposing factor. Primary necrotizing fasciitis of the breast is rare in healthy women. In this article, we present a very rare case of breast necrotizing fasciitis in the context of the literature. We report the case of a 35-year-old female patient who had given birth two months prior to admission and developed necrotizing fasciitis of the breast during lactation. The patient presented to the emergency department with sepsis. Examination revealed widespread erythema, dark discoloration, edema, and necrotic areas indicative of wet gangrene and crepitation in the left breast. Necrotizing fasciitis is a rapid and aggressive disease that can be fatal, and delayed diagnosis may unfortunately result in death. Therefore, careful evaluation of all suspected cases, especially for patients with risk factors, is crucial for early diagnosis and timely treatment. This case highlights the importance of recognizing necrotizing fasciitis of the breast in lactating women to ensure prompt and appropriate management, potentially saving lives. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis is a rare but potentially lethal infection of the skin and soft tissue, commonly seen in the perianal and gluteal regions. Concomitant diabetes is a predisposing factor. Primary necrotizing fasciitis of the breast is rare in healthy women. In this article, we present a very rare case of breast necrotizing fasciitis in the context of the literature. We report the case of a 35-year-old female patient who had given birth two months prior to admission and developed necrotizing fasciitis of the breast during lactation. The patient presented to the emergency department with sepsis. Examination revealed widespread erythema, dark discoloration, edema, and necrotic areas indicative of wet gangrene and crepitation in the left breast. Necrotizing fasciitis is a rapid and aggressive disease that can be fatal, and delayed diagnosis may unfortunately result in death. Therefore, careful evaluation of all suspected cases, especially for patients with risk factors, is crucial for early diagnosis and timely treatment. This case highlights the importance of recognizing necrotizing fasciitis of the breast in lactating women to ensure prompt and appropriate management, potentially saving lives.

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Healthcare providers evaluating patients presenting with neurological, visceral, or cutaneous symptoms that are disproportionate to the expected severity may need to consider porphyria in the differential. Porphyria is an inherited condition in which toxic metabolites of the heme pathway are increased. Carriers of porphyrias are asymptomatic and will not present with classical symptoms, nor will levels be elevated, until the disease is induced by certain drugs, hormones, or idiopathic causes such as the stress of trauma. Acute intermittent porphyria (AIP), a form of acute porphyria, is a rare autosomal dominant disease that results in a dysfunctional porphobilinogen deaminase. This consequently increases neurotoxic porphobilinogen and subsequent increase in δ-aminolevulinic acid. Both of these metabolites cause neurovisceral symptoms that afflict the patient in acute attacks. We present a rare case of AIP manifested in a burn patient suffering a burn injury. The patient presented with symptoms indicative of AIP, including altered mental status and abdominal pain accompanied with a chronic history of alcoholism and smoking. A negative work-up, including imaging and findings of associated manifestations consistent with AIP led to a discovery of elevated porphyrins. The patient's course and death due to his injuries gives insight into the presentation of AIP in a burn patient. [ABSTRACT FROM AUTHOR]

Background: Distal lower extremity reconstruction is challenging. This study aims to propose a protocol for the treatment of traumatic soft tissue defects. The key concept is to combine the surgical armamentarium of the reconstructive surgeon with the advantages provided by hyperbaric oxygen therapy. Methods: This retrospective study analyzed data of 57 patients affected with unilateral or bilateral lower extremity trauma distal to the knee and involving soft tissues with no indication of immediate reconstruction between 2010 and 2021. Before the reconstructive procedure, all the patients underwent a stick swab procedure for the collection of microbiological samples and debridement. Patients were divided into two treatment groups and only one group underwent a combined therapeutic procedure with hyperbaric oxygen therapy. Negative pressure wound therapy (NPWT) was employed only if deemed necessary according to the defect's depth and wound exudate. Surgical techniques, outcomes, and complications were discussed. Results: All patients achieved a complete recovery with no major complications and only minor complications observed. The study group treated with HBOT had a lower complication rate and lower percentages of minimal and partial graft loss compared with the same complications observed in the control group. No patients experienced HBOT-related complications. Significant reductions in the time to complete healing and the time from reconstruction to healing were found (p = 0.002 and p < 0.00001, respectively). Conclusions: A lower complication rate was observed in the group treated with HBOT. The administration of HBOT prior to soft tissue reconstruction significantly reduced the time to complete healing and the time interval from skin grafting to healing. However, prospective studies and randomized trials with larger cohorts should be designed to investigate the efficacy of HBOT for the treatment of lower extremity injuries with extensive soft tissue defects. [ABSTRACT FROM AUTHOR]

We review a case of total penile skin replacement with split-thickness micromesh skin graft (micromesh STSG) due to paraffinoma.

Penile strangulation secondary to utilization of a constrictive ring is a rare urologic emergency that requires urgent decompression to prevent prolonged vascular obstruction resulting in necrosis and gangrene. Current literature is mainly comprised of case presentations that focus on management in the acute setting via removal of the ring. Herein, we describe surgical management of a patient who presents in delayed fashion after self-removal of the constrictive ring. We discuss our penectomy-sparing technique of debridement and split thickness skin graft.

Minimally invasive surgery is becoming the standard of care across surgical subspecialties. Several new "minimally invasive" options for burn debridement and autografting exist. Enzymatic bromelain-based debridement (BBD) and autologousskin cellspray (ASCS) have independently proven to reduce the rate of split-thicknessskin grafting (STSG) and decrease donor site size when grafting is performed. There is a paucity in the literature regarding the combination of these two therapies. The purpose of this study is to characterize a cohort of patients treated with both BBD andASCS and qualitatively compare data to expected outcomes without these therapies. This retrospective study of a single academic burn center's experience using BBD and ASCS together included 13 patients with a total burn surface area (TBSA) from 1-30% and all had >50% deep partial thickness. All patientsreceived BBD andASCS. Deeper burns additionally received STSG with ASCS overspray. Median burn size was 14% TBSA (IQR:5.45,20), donor site size was 225 sq cm (IQR:28.5,556.5), and ratio of donor site area to total treatment area of 0.082 (IQR: 0.039, 0.241) was observed. Median observed length of stay (LOS) was 19 days (IQR:10,27), expected LOS was 15.4 days, and O/E ratio 1.06. Donor sites in both groups of patients were much smaller than expected versus treatment with conventional meshed STSG alone and length of stay islower than expected based on burn size. An emphasis on expenses and scar development will guide future studies into the patient subset and wound features that are best for this combination treatment. [ABSTRACT FROM AUTHOR]

Background: Hidradenitis suppurativa (HS) can present significant physical, psychological, social, and financial burden. Here, we describe surgical and quality of life outcomes for adolescent patients with axillary Hurley stage 3 HS who underwent staged surgical management. Methods: We performed a single-center, retrospective review of patients ≤21 years who had axillary Hurley stage 3 HS. A standardized, staged surgical approach was implemented. Primary outcomes were length of stay, length of negative pressure wound therapy (NPWT) use, number of operations, range of motion, and graft uptake. Secondary outcome was depression, suicidal ideation, and social changes including return to school or work. Results: Nine adolescent female patients with axillary Hurley stage 3 HS were included, of whom 6 underwent surgery (9 total sites) and 3 remained on medical therapy. Patients had 6.5 ± 4.6 visits to the emergency department prior to surgery referral and had undergone 7.5 ± 5.1 incision and drainage procedures. For patients undergoing surgical management, NPWT duration was 23 ± 4 days, with 2–3 NPWT changes. Graft uptake was 80–100 % with 100 % return of full range of motion. No disease recurrence has been noted. All patients undergoing surgical management reported improvement in depression and suicidal ideation. Conclusion: Well-defined staged surgical approach for axillary Hurley stage 3 HS can offer adolescent patients disease eradication, improvement in range of motion, and improvement in quality of life. Study type: Retrospective review, case series. Level of evidence: IV.

Our objective was to compare the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. A systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, and an electronic search was conducted to identify all Randomised Controlled Trials and non-randomised studies comparing the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. Primary outcomes included development of post-graft contracture and the necessity for surgical release. Secondary outcomes consisted of evaluation of function, cosmesis and colour, scar and feeling, hair growth, and other complaints. For the analysis, fixed effects modelling was applied. Results: ten non-randomised trials with a total of 532 grafts were found. Full thickness skin grafts exhibited a statistically significant decrease in the development of post-graft contracture (Odds Ratio [OR] = 0.35, P = 0.0001) and later surgical releases (OR = 0.06, P = 0.00001). For secondary outcomes, full thickness skin grafts outperformed split thickness skin grafts in post-operative functional ability. However, split thickness skin grafts, showed to be superior in scar, aesthetic, and colour assessments, and less hair growth was observed for split thickness skin grafts. No significant difference was seen in sensation and donor or recipient site complaints. Overall, full thickness skin grafts are a better alternative for paediatric hand burns than split thickness skin transplants because they are linked with reduced post-graft contracture and the requirement for surgical release. • Full thickness skin grafts (FTSG) have lower occurrence of post-graft contracture than split thickness skin grafts (STSG). • FTSGs have are associated with less need of surgical release of post-graft contractures. • STSGs are associated with better cosmetic outcomes than FTSGs. [ABSTRACT FROM AUTHOR]

Full thickness total scalp avulsion injuries present a complex reconstructive challenge. Here we present a case of a 32-year-old female with an extensive full thickness scalp avulsion injury from a fishing boat engine accident that led to a unique injury pattern and loss of pericranium. This case report demonstrates the effectiveness of acellular dermal matrix and split thickness skin grafting in reconstruction of full thickness scalp avulsion injuries where there is significant loss of pericranium. After this patient's reconstruction, six-month postoperative follow up demonstrated an acceptable functional and esthetic outcome.

Introduction: Hidradenitis suppurativa (HS) is a chronic skin disease that significantly reduces the quality of life of patients, especially affecting the intimate areas. Surgical treatment is one of the tools available for treating HS, which can significantly improve patients' quality of life. Aim: To evaluate the surgical treatment of 31 patients treated surgically at the Centre for Burns Treatment in Siemianowice Śląskie, with a follow-up of 6 months. Material and methods: Thirty-one HS patients were operated on with classical reconstructive methods. The patients were followed up for 6 months in the outpatient clinic. We gathered clinical data of 31 post-operative patients and statistical analysis was performed. Results: 83.87% of the patients were completely healed. The study showed that HS recurrence in the surgical site occurred in 1 (3.23%) patient only after 6 months of follow-up. We found a statistically significant (p < 0.050) positive correlation between patients' age and body mass index (BMI), disease duration and time of diagnosis. BMI value additionally correlated with disease duration and time of diagnosis, while disease duration correlated with time of diagnosis. Conclusions: Surgical treatment is an effective method in HS. The relatively low recurrence rate after 6 months and, in most patients, full healing, support the good therapeutic effect of surgical treatment. [ABSTRACT FROM AUTHOR]

Background and Objectives: A skin graft is a segment of dermis and epidermis that is separated from its blood supply and donor site and transplanted to another recipient site on the body. STSGs consist of the epidermis and a portion of the dermis. There are two techniques of harvesting a STSG - tumescent and non-tumescent. The objectives of this study were to compare blood loss during harvesting a STSG, post-operative pain of the patient, healing of donor site and to compare graft take rate with tumescent and non-tumescent techniques. Methods: A total of 56 patients who fit the inclusion criteria were alternatively assigned into two treatment groups of tumescent and non-tumescent technique. Intraoperative bleeding was assessed by noting the percentage of a standard gauze piece soaked with blood when placed on the donor site. Post-operative pain was assessed using the VAS score. Healing of the donor site was assessed on post-operative days 10 and 15 by noting the percentage of epithelialisation occurred whereas that of the recipient site was assessed on post-operative days 5, 10 and 15 by noting the percentage of graft take. Results: Intra-operative bleeding was significantly lower in patients who underwent tumescent technique over those who underwent non-tumescent technique with p-value < 0.001. There was no difference in the post-operative pain between the two techniques. The technique of harvesting the STSG did not affect either the healing of the donor site or the graft take at the recipient site. Conclusion: Tumescent technique is a safer and better alternative to non-tumescent technique as the intra-operative bleeding is significantly lower in the former. Also, since it does not affect the healing of the donor or the recipient site, it is a good alternative to non-tumescent technique. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa is a chronic disease that significantly reduces patients' quality of life. Patients are chronically treated with systemic therapies, which are often ineffective. Surgical treatment for severe cases of hidradenitis suppurativa is one option for affected patients. Surgical treatment has its limitations, and wound closure may be particularly problematic. This requires the use of reconstructive techniques. The methods of choice for wound closure are split-thickness skin grafts or local flaps reconstructions. However, each method has its limitations. This is a presentation of a new reconstructive surgical method in hidradenitis suppurativa surgery: the use of a co-graft of Acellular dermal matrix and split thickness skin graft as a novel method in wound closure after wide excisions, based on two cases. The results of this method are very promising: we achieved very fast wound closure with good aesthetic results regarding scar formation. In this paper, we used several examinations: laser speckle analysis, cutometer tests, and health-related quality of life (QoL) questionnaire to check the clinical impact of this method. Our initial results are very encouraging. ADM with STSG as a co-graft could be widely used in reconstructive surgery. This is a preliminary study, which should be continued in further, extended research. [ABSTRACT FROM AUTHOR]

Background: Oral submucous fibrosis is a chronic, progressive, scarring, precancerous condition of oral mucosa which on progression causes severe trismus. Aim and Objectives: To compare and evaluate the efficiency of buccal fat pad, platysmal mucocutaneous flap, nasolabial flap, collagen membrane graft, split thickness skin graft and temporoparietal fascia in reconstruction of surgical defect created by excision of fibrous bands in oral submucous fibrosis. Results: After 6 months of follow-up, the interincisal mouth opening was 40.0 mm in case of buccal pad fat, 24.5 mm in temporoparietal fascia flap group, 33.8 in collagen membrane graft group, 34.5 mm in platysma flap group, 34.7 mm in nasolabial flap group, 29.3 mm in split thickness skin graft. ANOVA statistical analysis for postoperative interincisal distance at various time intervals and between pre-, intra- and postoperative interincisal distances were carried out which showed the results were significant at p value < 0.05 in all groups. No postoperative complications were noted in buccal fat pad group, split thickness skin graft group and collagen membrane group. However, platysmal group had flap necrosis and temporoparietal flap group patients had to undergo a second debulking procedure after one month. Conclusion: From our study, we concluded buccal fat pad yields superior results with respect to postoperative mouth opening and related complications. [ABSTRACT FROM AUTHOR]

We review a case of total penile skin replacement with split-thickness micromesh skin graft (micromesh STSG) due to paraffinoma., Competing Interests: No., (© 2024 The Authors.)

Fournier gangrene (FG) is a life-threatening necrotizing soft-tissue infection of the perineum and external genitalia, which primarily occurs in obese, diabetic males. The mainstay of treatment is source control via early aggressive surgical excision. Wide surgical excision can result in significant soft tissue defects that can be disfiguring and difficult to close. The most common method of closure is split-thickness skin grafting (STSG). Recently, autologous skin cell suspension (ASCS) technology has been used in addition to STSG to provide better wound healing and closure. This patient experienced excellent wound progression, following FG, through the application of ASCS with STSG, despite challenges related to the wounds, anatomical location, comorbidities, size, and the patient's medical history., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, English et al.)

Aplasia cutis congenita (ACC) is a rare congenital disease defined by the absence of skin, most commonly on the scalp. While the exact incidence remains uncertain, ACC presents a significant challenge in clinical management due to its variable presentation and associated complications. We present the case of a newborn male with a large scalp defect attributed to ACC, complicated by a life-threatening scalp hemorrhage. Despite challenges in management, including recurrent infections and failed skin grafts, the patient ultimately achieved satisfactory healing following a series of surgical interventions, including local transposition flap procedures. This case underscores the importance of a multidisciplinary approach to managing ACC, tailored to individual patient characteristics and associated risks. While discrete lesions of ACC typically have a favorable prognosis, extensive defects pose significant risks of morbidity and mortality, highlighting the need for careful consideration of treatment options and close clinical monitoring of affected individuals., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jumei’an et al.)

Penile strangulation secondary to utilization of a constrictive ring is a rare urologic emergency that requires urgent decompression to prevent prolonged vascular obstruction resulting in necrosis and gangrene. Current literature is mainly comprised of case presentations that focus on management in the acute setting via removal of the ring. Herein, we describe surgical management of a patient who presents in delayed fashion after self-removal of the constrictive ring. We discuss our penectomy-sparing technique of debridement and split thickness skin graft., (© 2024 The Authors.)

Purpose: To report long-term results and patient reported outcomes of staged anterior urethroplasties, and isolate risk factors for recurrence. Methods: We reviewed urethroplasty database for all patients who underwent staged urethroplasty from 2000 to 2017. Follow-up included a cystoscopy 4 months after their 2nd stage to assess early success, and then annual follow-up thereafter with post-void residual and symptom assessment. Stricture characteristics, etiology and graft type were analyzed with regards to success. Results: Forty-nine patients were eligible for inclusion. The median stricture length was 7 cm (3–17 cm). The early success rate demonstrated by cystoscopy at 4 months was 100%. Long-term success was 96.4% in buccal graft (BMG) only patients; however, long-term success fell considerably to 53% in patients requiring any use split thickness skin graft (STSG) in the first stage. Median follow up time was 57 months (6–240 months). On analysis, age, increased stricture length and especially the use of STSG all appeared to be associated with late recurrence. The recurrence group had longer stricture length and were more likely to be panurethral. All recurrences occurred after the initial 4-month cystoscopy with a median time to recurrence of 78 months. Conclusion: Staged repairs that are amenable to BMG-only repairs have high long-term success rates. Increasing stricture length and the addition of split-thickness skin graft were associated with lower success rate in staged urethral reconstruction. Patients requiring staged repairs often experience recurrence in a very delayed fashion reinforcing the need for close, long-term follow up. [ABSTRACT FROM AUTHOR]

Background: Cutaneous pillar leiomyoma (CPL) is a benign skin tumour of errector pili muscles and is rare condition. Clinically it appears as small nodule which are in the form of small groups. These are tender to touch, pressure, cold, and emotional stimuli. Different modalities have been tried to reduce pain and discomfort. Surgery is a treatment of choice in lesion which are very tender and associated with disturbance of social life. The objective of treatment in to achieve complete cure from pain with functional and aesthetic improvement. Case: A case of a male patient age 28 years, with multiple cutaneous leiomyomas on the left anterior chest wall and lateral chest wall. On clinical examination there were multiple nodular skin lesions that manifested as brownish erythematous. The lesions increased gradually during the last 2 years, extending to the left lateral chest wall. Complete surgical excision of tumor was done, followed by coverage with split thickness skin graft taken from the thigh. Patient was followed up fortnightly up to six month. Results: After surgical treatment, there was complete pain relief and acceptable cosmetic outcome, which allowed the social reintegration. Conclusion: Cutaneous pilus leiomyomas is difficult to treat. The radical resection of tumor is important to resolve the symptoms with prevention of tumor recurrence. [ABSTRACT FROM AUTHOR]

Introduction Split thickness skin graft (STSG) is a commonly carried out procedure in granulating wounds. The graft may be applied directly on the granulation tissue (without scrapping) or it may be applied after complete removal of the granulation tissue (after scrapping). Surgeons are divided on this issue. Methods A single blinded, randomized, controlled trial was carried out between November 2017 and December 2018 in the Department of Plastic Surgery and Burns, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The study consisted of 62 patients who were divided into two groups. Group A consisted of patients undergoing removal of granulation tissue and Group B included patients on whom the skin graft was directly applied on the granulation tissue. On the 10th post-operative day, assessment of the graft take was done. Results There was no statistically significant difference in graft take between group A and group B (p=0.59). The average drop in hemoglobin levels after the surgery was 1.6 gm% in group A and 0.4 gm% in group B and this difference was statistically significant. Also, the drop of serum protein after surgery was 8.6% gm/dl in group A and 1.0 gm/dl in group B and this difference was significant. Conclusion There was no significant difference in the take of skin graft with or without removal of granulation tissue in our study. However, with lesser blood loss, lesser protein loss and lesser operative time, this study favours skin grafting without the removal of granulation tissue. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa is a chronic disease that significantly reduces patients’ quality of life. Patients are chronically treated with systemic therapies, which are often ineffective. Surgical treatment for severe cases of hidradenitis suppurativa is one option for affected patients. Surgical treatment has its limitations, and wound closure may be particularly problematic. This requires the use of reconstructive techniques. The methods of choice for wound closure are split-thickness skin grafts or local flaps reconstructions. However, each method has its limitations. This is a presentation of a new reconstructive surgical method in hidradenitis suppurativa surgery: the use of a co-graft of Acellular dermal matrix and split thickness skin graft as a novel method in wound closure after wide excisions, based on two cases. The results of this method are very promising: we achieved very fast wound closure with good aesthetic results regarding scar formation. In this paper, we used several examinations: laser speckle analysis, cutometer tests, and health-related quality of life (QoL) questionnaire to check the clinical impact of this method. Our initial results are very encouraging. ADM with STSG as a co-graft could be widely used in reconstructive surgery. This is a preliminary study, which should be continued in further, extended research.

Plexiform Neurofibroma (PNF) presents as a growth of unexplained excess that does not pertain to any other organic causes and is hereditary. The iconic ‘bag of worms’ appearance is native to its diffuse and pliable character. Region of occurrence being the face adds the challenge of aesthetics to infiltration into vital structures and recurrence rate. The patient presented here is that of serial reconstructions done in order to satisfy the aesthetic demand of the patient. Initial reconstruction done with split thickness skin graft was later augmented with radial forearm flap. No signs of recurrence were seen during the follow-up of six years.

Whilst there is a trend away from aggressive nonorgan sparing surgical treatments for malignant penile disease, a variety of penile preservation options exist but functional outcomes and patient reported outcomes (PROs) in this area are poorly reported to date. The aim of this study is to report functional outcomes and PROs of total glans resurfacing (TGR) in a consecutive series of patients with lichen sclerosis (LS) or localized penile cancer (PC). From 2004 to 2018 a consecutive series of patients underwent TGR for the management of LS or localized PC in a tertiary referral network. Patient clinical records and operative notes were retrospectively reviewed. Statistical analysis was conducted with Stata 12. Urinary and sexual outcomes were recorded utilizing both the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) validated questionnaires while PROs were extrapolated from a 5-item "ad hoc" telephone questionnaire administered at 1 year post procedure. 37 consecutive patients were enrolled. Histology results demonstrated LS in 16 patients, with the remaining 21 having a diagnosis of PC. The most common reasons for patient presentation were local pain (32.4%), pruritus (37.8%) and bleeding (29.7%). Median follow-up was 22 (IQR 13–77) months. Median age was 62 (IQR 55–68). Neither of the questionnaires assessing urinary and sexual function showed any significant deterioration after surgery. Glans sensitivity was fully maintained in 89.2% of cases. 94.5% of patients reported to be fully satisfied with the aesthetic appearance of the penis and would consider undergoing the same procedure again if necessary. 91.9% of patients would recommend the same procedure to someone else. An overall improvement of the quality of life was reported by 86.4% of patients. TGR should be considered a treatment of choice for selected cases of benign or malignant penile lesions Our study has some limitations, the first being its retrospective nature. Furthermore, despite being one of the largest series to date, follow-up duration is somewhat limited and a control group is lacking. TGR represents an excellent surgical option ensuring satisfactory voiding and sexual function, as well as cosmesis for selected cases of penile lesions. M. Preto, M. Falcone, G. Blecher, et al. Functional and Patient Reported Outcomes Following Total Glans Resurfacing. J Sex Med 2021;18:1099–1103. [ABSTRACT FROM AUTHOR]

Split-thickness skin grafts are often applied in the management of primary cutaneous melanoma. It is routine surgical practice to use the contralateral limb because of the alleged risk of donor site metastases that may occur when the ipsilateral limb is used. The rationale and clinical evidence for this routine were assessed in light of current understanding of pathways of metastasis of melanoma. We found the preference for the contralateral limb to go back to Paget's ideas on melanoma spread from 1889, and the clinical observation of five cases of split-thickness skin graft donor site metastases in a series of 226 tumours, published in 1962. We traced ten additional reported cases of melanoma metastases occurring in the skin graft donor site. Contralateral donor sites were involved in seven of these cases. In light of current knowledge, the occurrence and the location of any split skin donor site metastasis are to be considered as mere indicators of an aggressive course of systemic disease. Any location of a split skin donor site, whether ipsilateral or contralateral in relation to the primary tumour, may become the location of metastases but chances that such metastases occur are extremely rare. Because of the lack of evidence in favour of the use of the contralateral limb and because of sound considerations in favour of using the ipsilateral limb, we conclude that there is no objective argument to sustain the dogmatic ban of the ipsilateral limb as a donor site for a split-thickness skin graft in melanoma surgery. [ABSTRACT FROM AUTHOR]

Abstract 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.

Objective: To determine the frequency of success of acellular dermal matrix and split thickness skin graft in release of post burn contractures in hand using Vancouver scar scale. Study Design: Descriptive Case Series. Setting: Department of Plastic Surgery, Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: 1st March, 2019 to 30th October, 2019. Material & Method: A descriptive case series conducted at Plastic Surgery Department, Jinnah Burn and Reconstructive Surgery Center, Lahore. A sample size of 75 patients, who full filled the inclusion criteria, was selected through non probability consecutive sampling Informed consent was obtained from all the patients. Pre-operative photography was done to compare the post-operative results. After the release of contractures, coverage with acellular dermis and split thickness skin graft was performed. All the patients were followed up to 2 months and the outcome was assessed by Vancouver Scar Scale. The collected data was entered and analyzed by using SPSS version 20. Descriptive statistics were calculated. Quantitative variables like age, size of scar were presented as mean, ± standard deviation. Qualitative variables were presented as frequencies and percentages. Results: Mean age of patient was 30 ± 9 years. Among them 40 were males and 35 females. Vancouver scale showed successful outcome (score ≤4) in 70.66 % of the patients. Partial release of contracture was the major complication seen in 5.33% of cases. Conclusion: Acelluar dermal matrix followed by split thickness skin graft is a very reliable option for coverage after release of post-burn contractures in hand as it provides very pliable, thin and lax skin with good color match and better contour to surrounding tissue. [ABSTRACT FROM AUTHOR]

Artificial dermal skin substitutes (ADSS) in combination with split-thickness skin grafts (STSG) are a valuable option for reconstruction of skin- and soft tissue-defects. However, successful incorporation of ADSS can be limited by various factors. We investigated the anticipated benefits of negative pressure wound therapy (NPWT) as an adjunct to support integration of ADSS, in a retrospective, comparative cohort study. We performed a retrospective, non-blinded, non-randomized comparative study including 86 patients with various soft-tissue defects, managed by application of either ADSS with or without NPWT based on the surgeon's preference. Outcome measurements comprised ADSS and skin graft take rates and analysis of treatment duration and time to wound healing. Additionally, patients were analyzed for the occurrence of hematoma, seroma, wound infection, and lack of substitute or skin graft adhesion. Demographic data and individual risk factors did not differ with statistical significance between both groups. The combination of ADSS with NPWT led to significantly improved rates of ADSS integration (89 vs. 70.1%; p = 0.035) and skin graft take (91 vs. 76%; p = 0.049) compared to standard wound dressings without NPWT. In addition, while differences in the incidence of seroma were neglectable, NPWT application led to significantly reduced rates of infection of ADSS (2.2 vs. 7.3%; p = 0.043). Moreover, STSG could be performed on average 4 days earlier with the application of NPWT (p = 0.031). The addition of NPWT to ADSS is a helpful adjunct that reduces time of incorporation and vascularization and improves clinical success rates. [ABSTRACT FROM AUTHOR]

We present you an early result of 38 year old man, who was operated in 2020 using meshed split-tickness skin graft (mSTSG) for paraffinoma localized to the penis and pubic area. Here we present picture of pre – and postoperativ view of the penis and describe the surgical procedure.

Objective: To determine the frequency of the successful graft take of Integra™ and split thickness skin graft after the release of post-burn neck contracture. Study Design: Descriptive Case Series. Setting: Department of Plastic Surgery, Jinnah Burn and Reconstructive Surgery Centre, Lahore. Period: 1st October, 2017 to 30th September, 2018. Material & Methods: A total of 70 cases, those who full filled the inclusion criteria were included in the study through non-probability consecutive sampling. Informed consent was obtained from all the patient. Integra was applied in all the patients after the release of contracture and excision of scar tissue and was inspected every 3-5 days. After 3 weeks, the outer layer of silicone sheet was removed and replaced by thin split-thickness skin graft. The graft was secured with skin staples, absorbent gauze and the crepe bandage. All the patients were followed up regularly and the final outcome was assessed at 6 weeks. Results: The mean age of the patients was observed as 34.51 ± 14.19 years with age range of 11to 59 years. Among these 70 patients 61.4% were male and 38.6% were females. The mean body mass index was observed to be 22.59 + 3.68 kg/m2. Out of these 70 patients, the outcome in terms of successful graft take with Integra treatment was achieved in 60 (85.7%) patients. On stratification, statistically insignificant difference was observed for the effect modifiers like age, gender and BMI. Conclusion: In our study we found that Integra and STSG can be considered as one of emerging and promising modality in burn management and reconstructive surgery with the significantly high success rate in terms of complete re vascularization and skin graft take. [ABSTRACT FROM AUTHOR]

Background: Surgical strategy of buried penis depends on the etiology and quality of affected and surrounding tissues, as well as overall anatomy of the external genitalia. Patients and methods: The authors describe the surgical principle of aquired buried penis reconstruction after previous partial amputations while using principles of split-thickness skin grafting (STSG), prepubic lipectomy and scrotoplasty. A 65 yrs old patient after biopsy proven squamous cell carcinoma of the penis, had undergone a glansectomy with neo-glans reconstruction using STSG. A second procedure with neo-glans reconstruction and urethral flap reconfiguration was done, because of local recurrence. Shortly thereafter, due to a secondary infection of the penis shaft tissues, the patient developed a buried penis. Results: The surgical goal should repair voiding/sexual functioning and psychological well being, which have been achieved during short term follow-up. Conclusion: STSG is a valid alternative for advanced cases in patients with already compromised scrotum. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency of pain relief and re-epithelization of the donor site wound of split thickness skin graft with the use of honey dressing. Study Design: Descriptive Case Series. Setting: Plastic Surgery Department, Jinnah Burn and Reconstructive Surgery Centre Lahore. Period: From 1st January, 2019 to 30th November, 2019. Material & Methods: A total of 100 patients with healthy granulating wound were included in the study. All patients undergone operations under general anaesthesia by the same surgeon. The dressing was done by a layer of honey on gauze piece, wrapped around the donor wound site of split thickness skin graft. Patients were followed at the 7th post-operative day and outcome measures were noted. Pain was scored by the use of Visual analogue score (VAS) and re-epithelization was complete healing of the wound. Results: A total of 100 patients were enrolled with mean age of 33.11±9.72 years and there were 45% (45) females and 55% (55) male patients. Mean wound size was 7.70±1.83 cm2. At the 7th post-operative day follow up; pain relief was seen in 74% patients and re-epithelization was seen in 78% of patients. Both the outcome measures i.e. pain relief and re-epithelialization was effectively controlled with the use of honey dressing. Conclusion: Honey dressing is useful and effective on split thickness skin graft donor site in terms of pain relief and re-epithelization. [ABSTRACT FROM AUTHOR]

Introduction and objective: The lethal necrotizing fasciitis, Fournier's Gangrene, is initially managed with resuscitation, broad-spectrum antibiotics, and aggressive surgical debridement. While the initial management steps are widely described, the subsequent management of skin loss is sparse. Our objective was to focus on the reconstruction of the penile shaft skin loss after wide surgical debridement. Methods: A single case was documented from presentation, to treatment, and to recovery. The primary focus was the reconstruction of the penile shaft skin. The combined planning and efforts of genitourinary and plastic surgery were used to reconstruct the penile shaft skin using a split thickness skin graft. Results: The penis was tunneled into a viable skin flap of the suprapubic fat pad in response to the wide surgical debridement from the treatment of Fournier's Gangrene. The penis maintained its anatomic function during the healing process. A 12/1000-in. split thickness skin graft from the lateral thigh was chosen to replace the skin deficient. 13 months later, we were able to excise around the preputial collar, un-tunnel the penis and place the skin graft around the penile shaft. A vacuum dressing and foley catheter remained in place for 7 days during an uneventful post-operative course. Ultimately, we found split thickness skin graft successful in this penile reconstruction after Fournier's Gangrene. Conclusion: Complete penile shaft skin loss can be managed acutely with tunneling in the suprapubic fat pad, and can be reconstructed with a split thickness skin graft from the lateral thigh.

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. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis (NF) is a very fatal infection which is also known as flesh eating disease. Due to the rapid progression, early diagnosis, the use of broad spectrum antibiotics and aggressive surgical treatment are very essential to reduce morbidity and mortality. In some conditions, abdominal wall integrity cannot be maintained. Negative pressure wound therapy (NPWT) can be used for the management of acute and chronic wounds. Studies showed that negative pressure wound therapy combined with a split thickness skin graft (STSG) can help to heal wounds at NF. In this case, the patient suffered from type 1 NF caused by Pseudomonas aeruginosa, Klebsiella pneumoniae. We would like to demonstrate how to reconstruct an open abdominal wall after an endometrial carsinoma surgery with NPWT and STSG. [ABSTRACT FROM AUTHOR]

Split thickness skin grafting (SSG) is an important modality for wound coverage; however, it leads to donor site morbidity. Epidermal grafting (EG) is a promising option for autologous skin grafting which offers minimal donor site morbidity, though it is not known if EG is an effective clinical alternative for SSG. This study compared the efficacy of EG as an alternative to SSG in terms of wound healing outcomes, donor site morbidity, patient satisfaction and adverse events. EPIGRAAFT is a Phase 2, randomized, open-label trial with two parallel groups: EG and SSG. Patients referred for skin grafting with a healthy granulating wound bed were included. The co-primary endpoints were the proportion of wounds healed and donor site healing time. The secondary endpoints include donor site morbidity measured using Vancouver Scar Scale, mean time for complete wound healing, patient satisfaction assessed using a validated skin grafting questionnaire and incidence of adverse events. Of the 61 patients screened, 44 patients were randomized. There was no difference in the proportion of wounds healed at 6 weeks (p=0.366) and 3 months(p=0.24) as well as the mean time for wound healing (p=0.12). EG resulted in lower donor site morbidity (p=0.001), faster donor site healing time (EG: 4.86 days vs. SSG: 21.32 days) (p<0.0001), and higher overall satisfaction (p<0.001). There were no adverse events reported. This study demonstrated that EG has superior donor site outcomes with faster donor site healing and lower morbidity compared to SSG, while having comparable wound healing outcomes. Patients receiving EG also experienced higher donor site satisfaction compared to SSG. ClinicalTrials.gov identifier: NCT02535481 [ABSTRACT FROM AUTHOR]

Cryopreserved human skin allografts (CHSAs) are used for the coverage of major burns when donor sites for autografts are insufficiently available and have clinically shown beneficial effects on chronic non‐healing wounds. However, the biologic mechanisms behind the regenerative properties of CHSA remain elusive. Furthermore, the impact of cryopreservation on the immunogenicity of CHSA has not been thoroughly investigated and raised concerns with regard to their clinical application. To investigate the importance and fate of living cells, we compared cryopreserved CHSA with human acellular dermal matrix (ADM) grafts in which living cells had been removed by chemical processing. Both grafts were subcutaneously implanted into C57BL/6 mice and explanted after 1, 3, 7, and 28 days (n = 5 per group). A sham surgery where no graft was implanted served as a control. Transmission electron microscopy (TEM) and flow cytometry were used to characterise the ultrastructure and cells within CHSA before implantation. Immunofluorescent staining of tissue sections was used to determine the immune reaction against the implanted grafts, the rate of apoptotic cells, and vascularisation as well as collagen content of the overlaying murine dermis. Digital quantification of collagen fibre alignment on tissue sections was used to quantify the degree of fibrosis within the murine dermis. A substantial population of live human cells with intact organelles was identified in CHSA prior to implantation. Subcutaneous pockets with implanted xenografts or ADMs healed without clinically apparent rejection and with a similar cellular immune response. CHSA implantation largely preserved the cellularity of the overlying murine dermis, whereas ADM was associated with a significantly higher rate of cellular apoptosis, identified by cleaved caspase‐3 staining, and a stronger dendritic cell infiltration of the murine dermis. CHSA was found to induce a local angiogenic response, leading to significantly more vascularisation of the murine dermis compared with ADM and sham surgery on day 7. By day 28, aggregate collagen‐1 content within the murine dermis was greater following CHSA implantation compared with ADM. Collagen fibre alignment of the murine dermis, correlating with the degree of fibrosis, was significantly greater in the ADM group, whereas CHSA maintained the characteristic basket weave pattern of the native murine dermis. Our data indicate that CHSAs promote angiogenesis and collagen‐1 production without eliciting a significant fibrotic response in a xenograft model. These findings may provide insight into the beneficial effects clinically observed after treatment of chronic wounds and burns with CHSA. [ABSTRACT FROM AUTHOR]

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 × 103/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.

Contact burn injuries to the palm are common in toddlers. We report a case series of 82 paediatric patients (age 7–48 months) with contact burn injury of the palm. We share our experience and outcomes of using plantar split-thickness skin grafts for resurfacing of the paediatric palm. We found that despite the excellent colour and texture match, split-thickness skin grafts from glabrous skin during growth are prone to motion-limiting scare contracture. From this series, we conclude that full-thickness skin grafts remain the reference standard of care in paediatric patients' hands. We recommend that children with burn scars should have regular check-up examinations until they are fully grown. Level of evidence: IV [ABSTRACT FROM AUTHOR]