Split-thickness skin grafts remain central to the strategy of burn wound treatment. The dressing used to cover the donor wound site has a significant effect on healing parameters. The purpose of this study was to compare split-thickness skin graft donor site reepithelialization under Xeroform and Jelonet dressings. A dermatome was used to cut two consecutive strips of skin from 25 paired donor sites on the thigh, calf, or back of 19 participants. Standardization of the harvest method was achieved by using the same surgeon to harvest the compared skin graft strips, with attention to consistency of dermatome skin-thickness setting, downward pressure, and angle of dermatome approach. A strip of Xeroform or Jelonet was applied to one of each pair of wounds. Epidermal and dermal thickness was measured from biopsy specimens cut at the midpoint of each split-thickness graft strip. The day of final dressing separation was declared the day of complete donor reepithelialization (healing). The mean healing time for Xeroform and Jelonet was 10.4 +/- 2.6 days (n = 25) and 10.6 +/- 2.8 days (n = 25) (p = 0.76) at sites cut to a mean depth of 0.23 +/- 0.08 mm and 0.23 +/- 0.09 mm (p = 0.89), respectively. There was no correlation between graft thickness and healing time for sites dressed with Xeroform (r = 0.17) or Jelonet (r = 0.02). Donors sites reharvested 10 to 21 days after a prior harvest healed an average of 3.1 days earlier than virgin sites (8.4 +/- 1.6 versus 11.5 +/- 2.6 days, p < 0.001), although reharvested grafts were on average 0.05 mm thicker (p = 0.10). The mean thickness of reepithelialized donor-site epidermis (0.13 +/- 0.04 mm, n = 30) was found to be twice the thickness of virgin epidermis from the same sites (0.06 +/- 0.02 mm, n = 38, p < 0.001). Thirty-six grafts harvested with dermatomes set to cut 8/1000 inch (0.20 mm) deep ranged from 0.12 to 0.42 mm thick, with only eight of these grafts measuring within +/-10 percent of the desired thickness setting. Before donor dressing separation, Xeroform and Jelonet dressings were judged to be more comfortable by nine patients and one patient, respectively, whereas no difference was detected by six patients. The authors now use Xeroform as the preferred donor dressing.
This is the first report of a subungual superficial angiomyxoma. Excision followed 12 months of lesion growth and progressive index nail-plate elevation. The encapsulated mass was separated bluntly from the nail bed undersurface, although sharp dissection was required to split the periosteal interface. Five cases of subungual myxoma have been reported. Histologically, both superficial angiomyxoma and myxoma entities contain spindle and stellate cells within a myxoid stroma. Vascular and cellular elements found only in superficial angiomyxoma were identified in the featured lesion. Recurrence rates following superficial angiomyxoma excision are greater than those of myxoma. This patient did not experience recurrence after 11 postoperative months.Key Words: Angiomyxoma; Fingernail; Myxoma; Nailbed; Subungual L'angiomyxome sous-unguéal superficiel RÉSUMÉ : Il s'agit du premier compte rendu d'angiomyxome sous?unguéal superficiel. L'excision a fait suite à une croissance de la lésion accompagnée d'une élévation progressive de la table unguéale de l'index sur une période de 12 mois. La masse encapsulée a été carrément séparée du lit inférieur de l'ongle, mais une dissection méticuleuse s'est révélée nécessaire pour séparer l'interface périostique. Cinq cas de myxome sous-unguéal ont été déclarés. Du point de vue histologique, tant l'angiomyxome superficiel que les myxomes contenaient des cellules fusiformes et étoilées dans un stroma myxomateux. Des éléments vasculaires et cellulaires observés seulement dans l'angiomyxome superficiel ont été repérés dans la lésion en question. Le taux de récurrence suivant l'excision d'un angiomyxome superficiel est plus élevé que dans le cas des myxomes. Ce patient n'avait pas présenté de récurrence onze mois après l'opération.
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