A Simple Technique for Intraoperative Scalp Skin Graft Depilation Using Dermabond®

Skin grafting is an essential aspect of burn and wound reconstruction. Split-thickness skin grafts (STSGs) harvested from the scalp are used for wound and burn reconstruction. Skin grafts from the scalp bear hair and hair particles. Residual hair fragments and pieces of hair in the graft have been associated with many complications, including foreign body reaction similar to pseudofolliculitis and chronic inflammation that can lead to infections. It is important to remove the hair and the hair particles from the scalp graft before its application to the donor site. Traditionally, surgeons have employed some techniques including saline agitation and mechanical removal of the hair particles with forceps. These techniques are time consuming and can subject the graft to mechanical damage. There is another technique that has been described using an adhesive tape. This technique uses Ioban™ (3M Healthcare, St. Paul, MN), followed by a saline wash to remove hair from grafts prior to grafting. In this paper, we introduce a novel technique for intraoperative hair depilation prior to graft application to recipient site. We used Dermabond® (Ethicon, Bridgewater, NJ) to remove residual hair particles from the STSG donor. Our technique has several advantages: it is expeditious, it allows minimal mechanical damage to the graft, and can be used for patients with allergies to Ioban. Intraoperative Dermabond depilation of scalp STSGs is safe, easy, and effective

The Use of Local Medial Plantar Artery Flap for Heel Reconstruction: A Systematic Review.

BACKGROUND: Soft tissue reconstruction of the heel represents a daunting challenge for reconstructive surgeons, given the weight-bearing role and anatomical properties of the glabrous skin on the plantar surface. For soft tissue defects in this area, the medial plantar artery (MPA) flap has been described as an optimal reconstructive option. Many studies have reported on the use of the medial plantar artery flap for soft tissue coverage of the heel. There currently exists no systematic review on the topic. AIM: The aim of this article is to review the literature on the use of local medial plantar artery flap for heel reconstruction with a focus on overall flap viability and selected outcomes. METHOD: The authors performed a systematic literature review using EMBASE, Cochrane Library, Ovid Medicine, MEDLINE, Google Scholar, PubMed database, and grey literature. Studies were identified between 1981 and 2019. Peer-reviewed articles published in the English language were included. Articles were eligible if they contained original clinical outcomes on patients who underwent local medial plantar artery flap for reconstruction of heel defects. RESULTS: A total of 135 unique studies were identified. Eighteen (18) articles were included in the review and analyses, yielding a total of 277 local medial plantar artery flaps for heel coverage. The most common etiology for the reconstructed heel defect was ulcers (45.3%) followed by trauma (35.8%). The overall complete flap survival rate was n=272/277 (98.2%). The incidence of minor flap complication was n=26/277 (9.4%). Most of the flaps maintained protective sensation (n=147/148 [99.3%]), although the protective sensation tended to be inferior to the contralateral normal side. The rate of donor site morbidity was n=14/269 (5.2%). CONCLUSION: Local medial plantar artery flap for heel defect reconstruction is associated with a very high flap survival rate with very few flap related complications including donor site complications

Exophytic Adiposis Dolorosa (Dercum\u27s Disease) of the Thigh: A Case Report.

Adiposis dolorosa or Dercum\u27s disease is a rare lipomatous disorder characterized by painful lipomas. In this article, we report a case of rather large exophytic adiposis dolorosa causing difficulties with ambulation, and our surgical management of the disorder. To our knowledge, this is the first reported case of a large exophytic adiposis dolorosa of the upper medial thigh causing problems with mobility. This is also the first reported case of the use of a delayed split-thickness skin graft (STSG) after interval use of wound vacuum-assisted closure (VAC) following dermolipectomy. A 77-year-old female presented with a chronic mass on the medial aspect of her right thigh for over 40-50 years. She had noticed a recent rapid increase in size, causing some discomfort and interference with mobility and activities of daily living. The patient underwent an MRI with finding consistent with adiposis dolorosa. She underwent dermolipectomy and reconstruction of the resulting defect with a combination of partial primary closure, wound VAC, and delayed closure using STSG. Dermolipectomy with interval application of a wound VAC combined with delayed reconstruction with STSG is a feasible option for patients with large lesions of the extremity that causes difficulty with mobility and activities of daily living

Use of Negative-Pressure Wound Therapy With Instillation and Dwell Time: An Overview

The use of negative-pressure wound therapy (NPWT) has become an established therapy for wound management. There have been many advancements in the technology of NPWT including NPWT with instillation and dwell (NPWTi-d). NPWTi-d promotes wound healing by wound cleansing, irrigation, and nonexcisional debridement. NPWTi-d has been shown in comparative clinical studies to decrease the time to definitive wound healing and length of hospitalization. NPWTi-d-using a reticulated open-cell foam dressing with through holes (ROCF-CC)-has been postulated to facilitate solubilization, detachment, and elimination of infectious materials, such as slough and thick exudate, before or after operative debridement, and in cases where surgical debridement is not an option. The authors provide an overview on the use of NPWTi-d by reviewing the components of the system, proposed mechanism of action, clinical outcomes, and current consensus guidelines for its utilization