Full-thickness skin grafts for lower leg defects coverage: Interest of postoperative immobilization

Struk, Samuel; Correia, N.; Guenane, Y.; Revol, M.; Cristofari, S.

doi:10.1016/j.anplas.2017.08.003

Cited by 11 publications

(24 citation statements)

References 11 publications

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“…A recent study by Kromka et al emphasized that this technique could be used to secure grafts to the wound bed, depending on the anatomic location and the preference of the surgeon performing the procedure [15]. It is challenging to perform a full-thickness skin graft (FTSG) on the lower extremities owing to the inevitable shearing forces associated with patient mobility, which can jeopardize the graft take rate and survival [3]. Struk et al conducted a study to evaluate the outcome of using the tie-over technique with a noncircular plaster cast as a postoperative immobilization method for covering lower leg defects [3].…”

Section: Discussionmentioning

confidence: 99%

“…It is challenging to perform a full-thickness skin graft (FTSG) on the lower extremities owing to the inevitable shearing forces associated with patient mobility, which can jeopardize the graft take rate and survival [3]. Struk et al conducted a study to evaluate the outcome of using the tie-over technique with a noncircular plaster cast as a postoperative immobilization method for covering lower leg defects [3]. The use of a noncircular plaster cast or custom-made splint with the tie-over technique minimized shearing force in the patients in their study, thereby indicating that a shorter immobilization period may improve FTSG survival [3].…”

Section: Discussionmentioning

confidence: 99%

“…Optimal fixation of skin grafts is necessary for a successful reconstruction [2]. The conventional tie-over bolster technique with splinting is one of the most commonly-used immobilization techniques for fixing the graft to the wound bed to achieve adequate postoperative graft adherence [3]. However, this technique has some disadvantages for both patients and clinicians.…”

Section: Introductionmentioning

confidence: 99%

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Retrospective Study on the Clinical Superiority of the Vacuum-Assisted Closure System with a Silicon-Based Dressing over the Conventional Tie-over Bolster Technique in Skin Graft Fixation

Chou

Hsieh

et al. 2019

Medicina

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Background and Objectives: The tie-over bolster technique has been conventionally used for skin graft fixation; however, long operative times and postoperative pain are the main disadvantages of this method. In this study, we introduce a new method using vacuum-assisted closure (VAC) with a silicon-based dressing as an alternative for skin graft fixation. This retrospective study aimed to evaluate the clinical effect of the VAC plus silicon-based dressing method and the conventional tie-over bolster technique for skin graft fixation in terms of pain, operative time, and skin graft take rate. Materials and Methods: Sixty patients who underwent skin graft surgery performed by a single surgeon from January 2017 to October 2018 were included in this clinical study. They were divided into two groups based on the type of treatment: tie-over bolster technique and vacuum-assisted closure (VAC), or silicon-based dressing groups. The operative times were recorded twice (during suturing or stapling of the graft and during removal of the dressing) in the two groups; similarly, pain was assessed using a numeric rating scale (NRS) after surgery and during dressing removal. Skin graft take rate was evaluated two weeks after dressing removal. Results: Twenty-six patients who met the eligibility criteria were enrolled into the study and assigned to one of the two groups (n = 13 each). No significant differences in age, gender, and graft area were noted between the two groups of patients. The VAC plus silicon-based dressing group demonstrated higher skin graft take rates (p < 0.05), shorter operation times (p < 0.05), and lower levels of pain (postoperative pain and pain during dressing removal) compared with the tie-over bolster technique group (p < 0.05). Conclusions: These findings indicate that VAC with silicon-based dressing can be used for skin graft fixation due to its superior properties when compared with the conventional method, and can improve the quality of life of patients undergoing skin graft fixation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retrospective Study on the Clinical Superiority of the Vacuum-Assisted Closure System with a Silicon-Based Dressing over the Conventional Tie-over Bolster Technique in Skin Graft Fixation

Chou

Hsieh

et al. 2019

Medicina

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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%

“…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%

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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Skin Graft Techniques

Khan

Khan²,

Nguyen

et al. 2020

Clinics in Podiatric Medicine and Surgery

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Full-thickness skin grafts for lower leg defects coverage: Interest of postoperative immobilization

Cited by 11 publications

References 11 publications

Retrospective Study on the Clinical Superiority of the Vacuum-Assisted Closure System with a Silicon-Based Dressing over the Conventional Tie-over Bolster Technique in Skin Graft Fixation

Retrospective Study on the Clinical Superiority of the Vacuum-Assisted Closure System with a Silicon-Based Dressing over the Conventional Tie-over Bolster Technique in Skin Graft Fixation

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

Skin Graft Techniques

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