There is an increasing trend towards early mobilisation post-split skin grafting of the lower limbs. This study was performed to determine if early mobilisation impacts negatively on graft healing and patient morbidity.
A retrospective review of 48 cases of lower limb split skin grafts performed by the plastic surgery department at Royal Perth Hospital was undertaken. Patients were stratified into early and late mobilisation groups.
No difference in outcome was identified with early mobilisation, but an increased rate of deconditioning with increased length of stay was present with late mobilisation.
These results suggest that early mobilisation post-split skin grafting of the lower limb is beneficial to patient care and is associated with lower morbidity.
"The HSSG procedure supports the concept of early mobilisation after a SSG procedure, which is known to reduce postoperative complications such as deep vein thrombosis while showing a similar outcome in healing times when compared to the traditional post-SSG bed rest protocols [7,8]. In contrast to flap-closure, the HSSG does not require sutures which is arguably an advantage in the elderly where flap closure requiring any significant tension causes a risk of ‘pull-through’ of suture material in the often friable, fragile skin of the leg. "
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to compare the results of the halo split skin graft (HSSG) by two primary care skin cancer practitioners at one clinic at the Gold Coast, Queensland, Australia, to the results of the only previous study while adding to the body of evidence regarding use of the HSSG following excision of non-melanoma skin cancer on the leg.
A retrospective review of the notes (Jan 2010-Aug 2012) was performed of all cases of nonmelanoma skin cancer (NMSC) excisions in which split skin graft (SSG) closure with the HSSG was utilized on the leg.
There were a total of 68 HSSGs included over the 31 months of the study. Average lesion size was 19.4 mm (range 9-75 mm) and the average age of patients was 78 years (range 49-95 years) with 49% of patients being male. The average healing time was 4 weeks with 35/68 (51%) healing within 14 to 21 days. The overall infection rate was 8/68 (11.8%), which decreased to 4/53 (7.5%) when the ankle grafts were excluded. The graft failure rate was 7/68 (10%) with 3/68 (4.4%) having both infection and graft failure.
This was a retrospective study.
The HSSG confines the surgical wounds to a single site, does not require specialized equipment and it is an economical and effective option for managing NMSC on the leg in situations where skin graft is indicated.
[Show abstract][Hide abstract] ABSTRACT: "The SCC Biopsy Tool" (name provided by current authors) is a double-bladed scalpel handle (manufactured and distributed by Surgidental Instruments, Deer Park, NY, USA) with two No. 11 scalpel blades (Swann-Morton, Sheffield, England) set in parallel, 1.5 mm apart (Figure 1). It provides an alternative to other partial biopsy methods and provides advantages over established techniques of shave and punch biopsy, particularly in differentiating squamous cell carcinoma (SCC) from keratoacanthoma (KA) on the leg and foot. The method of obtaining a full-thickness sample across the total width of a lesion with histologic sectioning in a longitudinal plane enables both architecture and cytology to be assessed accurately; precisely the requirement for distinguishing SCC from KA. The advantage over traditional incisional biopsy with a single blade is precision of parallel edges in a situation where central keratin provides an obstacle to such precision.
[Show abstract][Hide abstract] ABSTRACT: Lower limb skin grafts are thought to have higher failure rates than skin grafts in other sites of the body. Currently, there is a paucity of literature on specific factors associated with lower limb skin graft failure. We present a series of 70 lower limb skin grafts in 50 patients with outcomes at 6 weeks. One-third of lower limb skin grafts went on to fail with increased BMI, peripheral vascular disease, and immunosuppressant medication use identified as significant risk factors.
Dermatology Research and Practice 07/2014; 2014(2, article 4):582080. DOI:10.1155/2014/582080
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