Full-Thickness Skin Grafting with De-Epithelization of the Wound Margin for Finger Defects with Bone or Tendon Exposure

Abstract

BackgroundFull-thickness skin grafts (FTSGs) are generally considered unreliable for coverage of full-thickness finger defects with bone or tendon exposure, and there are few clinical reports of its use in this context. However, animal studies have shown that an FTSG can survive over an avascular area ranging up to 12 mm in diameter. In our experience, the width of the exposed bones or tendons in full-thickness finger defects is <7 mm. Therefore, we covered the bone- or tendon-exposed defects of 16 fingers of 10 patients with FTSGs.MethodsThe surgical objectives were healthy granulation tissue formation in the wound bed, marginal de-epithelization of the normal skin surrounding the defect, preservation of the subdermal plexus of the central graft, and partial excision of the dermis along the graft margin. The donor site was the mastoid for small defects and the groin for large defects.ResultsMost of the grafts (15 of 16 fingers) survived without significant surgical complications and achieved satisfactory functional and aesthetic results. Minor complications included partial graft loss in one patient, a minimal extension deformity in two patients, a depression deformity in one patient, and mild hyperpigmentation in four patients.ConclusionsWe observed excellent graft survival with this method with no additional surgical injury of the normal finger, satisfactory functional and aesthetic outcomes, and no need for secondary debulking procedures. Potential disadvantages include an insufficient volume of soft tissue and graft hyperpigmentation. Therefore, FTSGs may be an option for treatment of full-thickness finger defects with bone or tendon exposure.

Approach to Fingertip Injuries

“…18,19 A full-thickness skin graft (FTSG) was applied with caution over exposed bone and tendon in the mid twentieth century, but contemporary investigators have shown that a FTSG can be reliably used in the context of exposed bone or tendon. 20 We use skin grafts judiciously for pulp reconstruction, and we note imperceptible differences between glabrous and nonglabrous graft in the long term, because the graft remodels according to stress to which it is exposed (Fig. 5).…”

Rapid generation of three‐dimensional microchannels for vascularization using a subtractive printing technique

“…This is the depth that was set on the software but the specific depths of the channels were not measured after manufacturing for validation. These depths are sufficient for treating the entire thickness for many tissue‐engineered grafts (eg, full‐thickness skin grafts would be less than 7 mm thick ). The average channel width for all hydrogel types combined was 27.8 ± 5.1 and 45.6 ± 7.7 μm for 1.7 and 3.5 μJ, respectively (for all conditions combined with n = 6 or 7 spots/energy level).…”

A new surgical approach for pilonidal sinus disease: “de-epithelialization technique’’

“…Yoon et al (15) used this for reconstructing oral and/or oropharyngeal defects after surgically removing the tumor. Additionally, Jun Hee Lee et al (16) treated finger defects with exposed tendon or bone by using de-epithelialized cutaneous graft of the wound edges. Balat et al (17) obtained satisfactory result after using de-epithelialized rhomboid flap in the treatment of vulvar cancer.…”