Single-layer Integra for one-stage reconstruction of scalp defects with exposed bone following full-thickness burn injury: A novel technique
Department of Plastic Surgery, St James's Hospital, Dublin, Ireland.Burns: journal of the International Society for Burn Injuries (Impact Factor: 1.88). 10/2011; 38(1):143-5. DOI: 10.1016/j.burns.2011.08.019
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ABSTRACT: Various surgical procedures claim to show a high success rate in scalp reconstruction. However, it is still difficult to cover the wide range of scalp defects accompanied with skull exposure after cancer removal. Between March 2007 and March 2010, one-stage skin grafting with artificial dermis was performed in 8 patients with scalp defect accompanied with skull exposure after malignancy resection. A burr hole was made with several millimetre gap to the skull's outer table; thus, vascular diploic space was exposed. After the application of artificial dermis to the exposed vascular diploic space, the split-thickness skin graft was performed. As artificial dermis, AlloDerm, was used in 5 patients, whereas Matriderm was used in 3 patients. All patients were males and their mean age was 60.7 years. All patients had post-oncologic surgery defects. The mean defect size was 247.9 cm2. In all patients, skin graft was well-taken and radiation-induced skin defects occurred in 2 of 3 patients in whom a post-operative radiotherapy was performed, but these were cured by secondary intention. Average follow-up period was 19.6 months and all patients demonstrated stable coverage without having complications such as breakdown of skin graft or osteomyelitis that requires re-operation. To this end, our report on one-stage skin grafting with artificial dermis presents a reliable, simple and safe technique to cover exposed skull after cancer removal.
Article: The totality of burn care[Show abstract] [Hide abstract]
ABSTRACT: The overall improvement in mortality following severe burns has dramatically increased in the last half century with enhanced methods of resuscitation, treatment of inhalation injury, control of infection, early wound excision and novel methods of skin resurfacing. Although burn care begins at the onset of injury, reconstruction and rehabilitation feature highly throughout the various stages of treatment. Ultimately, we will have achieved little if the patient cannot be integrated back into society. For descriptive purposes burn care has been considered chronologically under the following headings: (1) First Two Minutes (Prehospital Care/First Aid), (2) First Two Hours (Emergency Room care), (3) First two days (resuscitation), (4) First Two Weeks (surgical excision and grafting), (5) First Two Months (rehabilitation and psychology), (6) First Two Years (reconstruction).
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ABSTRACT: Introduction: Dermal substitute are used for soft-tissue defect for their functional and aesthetic advantages. Matriderm® 1mm, single layer dermal matrix, composed of collagen and elastin covered by a split thickness skin graft simultaneously to its application, has been used most often in burned surgery. This prospective series evaluates the interest of this recent dermal matrix in reconstructive surgery. Patients and method: Twenty-eight patients have been treated with the substitute in our department for reconstructive surgery indication between November 2008 and May 2012. Indications were tissue losses treatment after limb or trunk sarcoma resection, melanoma, extended baso- or spinocellular carcinoma, palmoplantar keratodermy, burn sequels, or traumatic tissue losses. Indications were preferentially deep tissue losses, functional areas and the face. Results: Mean treated area has been 82.4 cm(2) (10 to 600 cm(2)). Mean taken rate has been 87±19% of the area and mean day of discharge has been 4.8 days and the mean cost per patient 906.5 euros. Negative wound therapy, until D3, was used 6 times. Three patients treated for limb sarcoma had radiotherapy performed on the grafted area. Aesthetic and functional results have been encouraging. Conclusions: Matriderm® 1mm, dermal substitute commonly used in acute burn treatment can be indicated in reconstructive surgery. This series show that it permits to obtain a good graft taken rate, a quick healing with a satisfying aesthetic and functional results and permit an early discharge. However, its indications are limited by its cost.
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