Efficacy and Complication Rates of Full-Thickness Skin Graft Repair of Lower Extremity Wounds After Mohs Micrographic Surgery

Oganesyan, Gagik; Jarell, Abel; Srivastava, Monika; Jiang, Shang I Brian

doi:10.1111/dsu.12254

Cited by 23 publications

(16 citation statements)

References 15 publications

(34 reference statements)

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“…Primary and delayed closure, as well as grafting of a wound are well documented options and should be attempted in both the simple wound, those where expedited recovery is required, or where more complex reconstructive failure would be disastrous [ 8 ].…”

Section: Reconstruction Options: the Reconstructionmentioning

confidence: 99%

Flap Decisions and Options in Soft Tissue Coverage of the Lower Limb

Jordan¹,

Malahias²,

Hindocha³

et al. 2014

TOORTHJ

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The lower extremities of the human body are more commonly known as the human legs, incorporating: the foot, the lower or anatomical leg, the thigh and the hip or gluteal region.The human lower limb plays a simpler role than that of the upper limb. Whereas the arm allows interaction of the surrounding environment, the legs’ primary goals are support and to allow upright ambulation. Essentially, this means that reconstruction of the leg is less complex than that required in restoring functionality of the upper limb. In terms of reconstruction, the primary goals are based on the preservation of life and limb, and the restoration of form and function. This paper aims to review current and past thoughts on reconstruction of the lower limb, discussing in particular the options in terms of soft tissue coverage.This paper does not aim to review the emergency management of open fractures, or the therapy alternatives to chronic wounds or malignancies of the lower limb, but purely assess the requirements that should be reviewed on reconstructing a defect of the lower limb.A summary of flap options are considered, with literature support, in regard to donor and recipient region, particularly as flap coverage is regarded as the cornerstone of soft tissue coverage of the lower limb.

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Section: Reconstruction Options: the Reconstructionmentioning

confidence: 99%

Flap Decisions and Options in Soft Tissue Coverage of the Lower Limb

Jordan¹,

Malahias²,

Hindocha³

et al. 2014

TOORTHJ

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“…Flap and graft reconstruction are the types of surgeries associated with the highest risk for SSI . Graft take in lower leg surgeries have been reported at rates of 64% to 90%, depending on the study . The risk of bleeding complications has previously been reported to be between 0.3% and 3% and for necrosis between 1.7% and 8.6% …”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported that the risk for postoperative complications within dermatological surgery has been between 0.7% and 29%, with some studies separately focusing on, for example, below the knee, dermatology inpatients, or FTSGs, all factors significantly influencing complication risk. 1,6,[13][14][15][16] The risk for infection has been between 1.3% and 8.7% 5,17 and exclusively for belowknee operations up to 30%. 2,4,6,18 In addition, poor preoperative skin condition and tumour ulceration 19 and patient characteristics such as diabetes, 20 smoking, 15,21 and age 3,19 are considered risk factors for surgical site infections (SSIs).…”

Section: Discussionmentioning

confidence: 99%

“…1,18 Graft take in lower leg surgeries have been reported at rates of 64% to 90%, depending on the study. 13,22,23 The risk of bleeding complications has previously been reported to be between 0.3% and 3% 1,5,16 and for necrosis between 1.7% and 8.6%. 1,5 Honaker et al 6 evaluated the complication risk of 69 patients in below-knee Mohs surgery, with an overall complication rate of 17%, of which 50% were infections, 3.25% delayed wound healing, 2.17% hypergranulation, and 8% hypertrophic scars.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluating complications in below‐knee skin cancer surgery after introduction of preoperative appointments: A 2‐year retrospective cohort study

Lindholm

Isoherranen

Schröder

et al. 2019

International Wound Journal

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Below‐knee dermatological surgery has a high risk of complications such as wound infection, bleeding, and necrosis. In this study, we evaluated the impact of preoperative appointments on complication risks. We searched the medical records of the Helsinki University Central Hospital (HUS) Dermatosurgery unit for all below‐knee surgeries during 2016, when no preoperative nurse appointments were carried out, and compared it with 2018, when preoperative appointments for risk patients were introduced. The study included 187 patients in 2016 and 179 patients in 2018, of whom 68 (about one third) attended preoperative appointments. At the appointments, risk factors were evaluated, and compression therapy was introduced when possible. The results show complication rates of 13.4% in 2016 vs 10.1% in 2018 (P = .33), despite significantly higher risks in the 2018 patient group. The odds ratio for complications in appointment attendees vs non‐attendees was reduced after adjustments to 0.58; however, this was insignificant (P = .47). The odds of complications for skin grafts were considerably higher: 11.33 vs other surgery techniques (P = .00). In conclusion, the introduction of preoperative appointments appeared to reduce complications in below‐knee surgery. For graft reconstructions, complication risk is high, even with carefully planned pre‐ and postoperative care. Further studies are needed to evaluate preventable risk factors of below‐knee graft reconstructions.

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“…Gestielte Lappenplastiken wie der mediale Hohlfußlappen oder der Suralislappen, Propellerlappen und bei größeren Defekten freie mikrovaskuläre Lappenplastiken, können diesem Anspruch möglicherweise gerechter werden [19]. Selbst Hautransplantate nach Wundkonditionierung mittles Vakuumversiegelung oder in Kombination mit Dermisäquivalenten auf Kosten einer längeren Behandlungsdauer mit mehreren Eingriffen, scheinen in manchen Fällen besser geeignet, einen stabilen Wundverschluss zu erzielen [20]. Trotz der immer wieder kleineren Komplikationen mit intensivierter Nachbehandlung lassen sich Defektgrößen von bis 35 cm² (ca.…”

Section: Introductionunclassified

Perforator Lappen “light” – der Stellenwert des Keystone Designed Perforator Flap Concept (KDPFC) an der unteren Extremität

Schepler

Sauerbier

Grabbe

et al. 2019

Handchir Mikrochir plast Chir

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Zusammenfassung Einleitung Mit der Originalpublikation des Keystone Designed Perforator Flap Concepts (KDPFC) von Behan et al. im Jahre 2003 hat der Keystonelappen mit Fallserien bis zu 300 Lappenplastiken Einzug in die Familie der Perforatorlappen gehalten. Die Lappenplastik, welche an die Form eines römischen Torbogens angelehnt ist, basiert auf dem Vorhandensein von Perforansgefäßen. Eine subtile Präparation der einzelnen Perforatoren ist dabei aber nicht notwendig. Hinzu kommt die insgesamt simple und rasche operative Vorgehensweise. Der Anwendungsbereich umfasst, bis auf wenige topografische Ausnahmen, das gesamte Integument. Die Anzahl aufschlussreicher Publikationen zu Komplikationen, Nachteilen oder lokalen Einschränkungen sind jedoch, trotz des breiten Anwendungsspektrums, spärlich. Methode Anhand einer retrospektiven Analyse von 35 Patienten über einen Zeitraum von 36 Monaten wurde der Stellenwert des Lappenkonzeptes nach überwiegender Hauttumorresektion an der unteren Extremität evaluiert. Die Lappenauswahl orientierte sich an der Defektsituation unter Anwendung der im Original beschriebenen Lappenvarianten. Ergebnisse Insgesamt wurden 36 Lappenplastiken an 35 Patienten durchgeführt. Die Defektgröße betrug im Mittel 21 cm2 (von 2 cm2 bis 100 cm2). Wundheilungsstörungen wurden in 12 Fällen sowie Teil-/Totale Lappenverluste bei 4 Patienten beobachtet. Allerdings bedurfte nur 1 Patient mit Lappenverlust einer weiteren operativen Intervention. Alle anderen heilten unter entsprechender Wundbehandlung komplett ab. Patienten mit blutverdünnender Medikation hatten erstaunlicherweise weniger Komplikationen (4 von 10), als Patienten ohne entsprechende Antikoagulation. Hier waren es 12 von 25 Patienten. Auffällig war das Auftreten von Komplikationen inklusive der Lappenverluste (n = 3) bei 7 Patienten, die eine Defektdeckung am distalen sprunggelenknahen Unterschenkel sowie am Fuß benötigten. Diskussion Obwohl in einigen Fällen Wundheilungsstörungen auftraten, stellt das KDPFC insgesamt einen wertvollen Baustein in der rekonstruktiven Leiter dar. Das Lappenkonzept ist dabei in der Lage zahlreiche andere lokale und regionale Lappenplastiken, auch bei komplexeren Situationen, ohne Qualitätsverlust, zu ersetzen. Der distale Unterschenkel und der Fuß sind Bereiche, an denen das Konzept allerdings nur bedingt anwendbar ist. Komplexere Lappentechniken scheinen für diese Region aufgrund der höheren Flexibilität und des Aktionsradius geeigneter.

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Efficacy and Complication Rates of Full-Thickness Skin Graft Repair of Lower Extremity Wounds After Mohs Micrographic Surgery

Abstract: FTSG is a consistent and safe reconstructive option for the management of lower extremity wounds after MMS.

Cited by 23 publications

References 15 publications

Flap Decisions and Options in Soft Tissue Coverage of the Lower Limb

Flap Decisions and Options in Soft Tissue Coverage of the Lower Limb

Evaluating complications in below‐knee skin cancer surgery after introduction of preoperative appointments: A 2‐year retrospective cohort study

Perforator Lappen “light” – der Stellenwert des Keystone Designed Perforator Flap Concept (KDPFC) an der unteren Extremität

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