Objective:To investigate the effect of a subcutaneous pedicle Limberg flap for the reconstruction of medium-sized skin defects in the face following skin tumor or scar excision. Methods: From August 2002 to June 2004,...Objective:To investigate the effect of a subcutaneous pedicle Limberg flap for the reconstruction of medium-sized skin defects in the face following skin tumor or scar excision. Methods: From August 2002 to June 2004,the subcutaneous pedicle Limberg flap was designed to repair facial skin defects in 17 patients(19 flaps),and the size of the lesions ranged from 2.0 cm×1.9 cm to 5.0 cm×4.5 cm.The operation was performed under general anesthesia in 2 children,and under local anesthesia in the remaining 15 patients. Results: All flaps survived with primary healing postoperatively.With a follow-up from 1 to 22 months,neither short-term nor long-term postoperative complications such as flap necrosis,hematoma,infection,visible dog-ear and trap door deformity were found,and functionally and cosmetically satisfactory outcomes were achieved. Conclusion: This subcutaneous pedicle Limberg flap provides a competitive repair alternative for the treatment of medium-sized skin defects in the face.展开更多
Objective: to analyze the clinical application effect of negative pressure sealing drainage (VSD) in skin defect complicated with infection wound. Methods: from June 2019 to June 2020, 39 cases of skin defect complica...Objective: to analyze the clinical application effect of negative pressure sealing drainage (VSD) in skin defect complicated with infection wound. Methods: from June 2019 to June 2020, 39 cases of skin defect complicated with wound infection in our hospital were listed as the reference group, and 39 cases of the same type treated from June 2020 to June 2021 were listed as the analysis group. With reference to the traditional treatment method in group A, VSD was used in the analysis group after debridement, and the clinical treatment related indexes and the effective rate of wound treatment were compared between the two groups. Results: the use time of antibiotics in the treatment of patients in the comparative analysis group was significantly shorter than that in the reference group, and the wound area of patients in the treatment analysis group was significantly larger than that in the reference group, all of which were statistically verified (P<0.05). After treatment, the total effective rate of two groups of patients was counted. The total effective rate of the analysis group was significantly higher, being 100.00%(39/39), and that of the reference group was 79.49%(31/39). It was verified that P<0.05. Conclusion: compared with the traditional treatment methods, VSD has more advantages in treating skin defects complicated with infected wounds, which can reduce the use of antibiotics by patients and help to reduce the wound area. Its total effective rate is obviously higher, and it is easy to operate, so it can be popularized.展开更多
Objective To introduce an effective reconstruction method for the finger injured with vessel and skin defect. Methods Free skin flap with skin vein was transplanted on the site of tissue defect, connecting by anastomo...Objective To introduce an effective reconstruction method for the finger injured with vessel and skin defect. Methods Free skin flap with skin vein was transplanted on the site of tissue defect, connecting by anastomosis the vein with artery or vein of the finger. Results Seven cases were treated with this method,among which 5 cases have sikin defect on the palm aspect of fingers, the rest have skin defect on the dorsal aspect skin of finger. All fingers survived with good shape and function. Conclusion This is a simple and effective method of finger reconstruction for the patients with defect of vessels and skin. 6 refs.展开更多
To report a method of repair facial skin defects with a skin flap of SMAS pedicle.Methods According to the size of defect of skin,design a skin flap with SMAS pedicle for repair of defect.Results The method has been s...To report a method of repair facial skin defects with a skin flap of SMAS pedicle.Methods According to the size of defect of skin,design a skin flap with SMAS pedicle for repair of defect.Results The method has been successfully applied for skin defects of eyelid and lip in 14 cases with satisfied results.The area of the largest flap was 5 cm×3 cm.Conclusion Repairing facial defects such as eyelid skin defect or lip skin defect with skin flap of SMAS pedicle is a very good method.The flap has a good blood supporting and satisfactory color and flexibility.5 refs,6 figs.展开更多
In young patients, even small circular facial defects after the excision of benign skin tumors present a reconstructive challenge. The usefulness of a V-Y advancement flap for reconstructing such defects is well docum...In young patients, even small circular facial defects after the excision of benign skin tumors present a reconstructive challenge. The usefulness of a V-Y advancement flap for reconstructing such defects is well documented. We refined this technique as a mini V-Y advancement flap consisting of two subcutaneous pedicles that vascularize the skin island via subdermal plexus lateral bridges. This technique was used for 21 middle-aged or younger patients with a small benign skin lesion. None of them experienced any postoperative complications. Aesthetically excellent results were found in all patients. This small advancement flap could be attempted as an alternative to fusiform excision of small skin lesions, particularly in younger patients.展开更多
The issue of skin defects is a major concern of almost every trauma surgeon after surgery. Despite numerous conventional methods and introduction of the reconstruction ladder, managing skin defects is still a challeng...The issue of skin defects is a major concern of almost every trauma surgeon after surgery. Despite numerous conventional methods and introduction of the reconstruction ladder, managing skin defects is still a challenge for the trauma surgeons. In recent years, parallel to the advances in the more conventional methods of skin repair, regenerative medicine has offered new and novel treatments. This article aims to explore these contemporary regenerative solutions as well as to review the conventional methods of treating skin defects.展开更多
Background:Split-thickness skin grafting is the current gold standard for the treatment of traumatic skin loss.However,for patients with extensive burns,split-thickness skin grafting is limited by donor skin availabil...Background:Split-thickness skin grafting is the current gold standard for the treatment of traumatic skin loss.However,for patients with extensive burns,split-thickness skin grafting is limited by donor skin availability.Grafting split-thickness skin minced into micrografts increases the expansion ratio but may reduce wound repair quality.Dermal substitutes such as Pelnac can enhance the healing of full-thickness skin wounds,but their application currently requires two surgeries.The present study investigated whether it is possible to repair full-thickness skin defects and improve wound healing quality in a single surgery using Pelnac as an overlay of minced split-thickness skin grafts in a rat model.Methods:A full-thickness skin defect model was established using male Sprague-Dawley rats of 10 weeks old.The animals were randomly divided into control and experimental groups in which Vaseline gauze and Pelnac,respectively,were overlaid on minced split-thickness skin grafts to repair the defects.Wound healing rate and quality were compared between the two groups.For better illustration of the quality of wound healing,some results were compared with those obtained for normal skin of rats.Results:We found that using Pelnac as an overlay for minced split-thickness skin grafts accelerated wound closure and stimulated cell proliferation and tissue angiogenesis.In addition,this approach enhanced collagen synthesis and increased the formation of basement membrane and dermis as well as the expression of growth factors related to wound healing while reducing scar formation.Conclusions:Using minced split-thickness skin grafts overlaid with Pelnac enables the reconstruction of fullthickness skin defects in a single step and can increase the healing rate while improving the quality of wound healing.展开更多
The healing of large skin defects remains a significant challenge in clinical settings.The lack of epidermal sources,such as autologous skin grafting,limits full-thickness skin defect repair and leads to excessive sca...The healing of large skin defects remains a significant challenge in clinical settings.The lack of epidermal sources,such as autologous skin grafting,limits full-thickness skin defect repair and leads to excessive scar formation.Skin organoids have the potential to generate a complete skin layer,supporting in-situ skin regeneration in the defect area.In this study,skin organoid spheres,created with human keratinocytes,fibroblasts,and endothelial cells,showed a specific structure with a stromal core surrounded by surface keratinocytes.We selected an appropriate bioink and innovatively combined an extrusion-based bioprinting technique with dual-photo source cross-linking technology to ensure the overall mechanical properties of the 3D bioprinted skin organoid.Moreover,the 3D bioprinted skin organoid was customized to match the size and shape of the wound site,facilitating convenient implantation.When applied to full-thickness skin defects in immunodeficient mice,the 3D bioprinted human-derived skin organoid significantly accelerated wound healing through in-situ regeneration,epithelialization,vascularization,and inhibition of excessive inflammation.The combination of skin organoid and 3D bioprinting technology can overcome the limitations of current skin substitutes,offering a novel treatment strategy to address large-area skin defects.展开更多
Background and objectives Skin defects are one of the primary problems that occur in post-harvest grading and processing of loquats.Skin defects lead to the loquat being easily destroyed during transportation and stor...Background and objectives Skin defects are one of the primary problems that occur in post-harvest grading and processing of loquats.Skin defects lead to the loquat being easily destroyed during transportation and storage,which causes the risk of other loquats being infected,affecting the selling price.Materials and Methods In this paper,a method combining band radio image with an improved three-phase level set segmentation algorithm(ITPLSSM)is proposed to achieve high accuracy,rapid,and non-destructive detection of skin defects of loquats.Principal component analysis(PCA)was used to find the characteristic wavelength and PC images to distinguish four types of skin defects.The best band ratio image based on characteristic wavelength was determined.Results The band ratio image(Q782/944)based on PC2 image is the best segmented image.Based on pseudo-color image enhancement,morphological processing,and local clustering criteria,the band ratio image(Q782/944)has better contrast between defective and normal areas in loquat.Finally,the ITPLSSM was used to segment the processing band ratio image(Q782/944),with an accuracy of 95.28%.Conclusions The proposed ITPLSSM method is effective in distinguishing four types of skin defects.Meanwhile,it also effectively segments images with intensity inhomogeneities.展开更多
BACKGROUND Although skin avulsions to male external genitalia are rare, they can be both physically and psychologically traumatic. Thus, the necessity for judicious management poses significant challenges to surgeons ...BACKGROUND Although skin avulsions to male external genitalia are rare, they can be both physically and psychologically traumatic. Thus, the necessity for judicious management poses significant challenges to surgeons in order to avoid potential permanent disabilities. We report a case of massive penoscrotal skin avulsion and a composite graft was creatively applied to cover the defect which achieved good results. We believe that this case is of great reference value for fellow surgeons.CASE SUMMARY A 52-year-old male presented with massive traumatic avulsion of the penile and scrotal skin following mishandling of an electric drill. The avulsed skin was missing. The patient was diagnosed with massive skin avulsion of external genitalia. Following initial complete debridement of devitalized or infected tissues, Pelnac dermal substitute was secured to the defect with the assistance of negative-pressure wound closure. In the final step, the silicone layer of Pelnac was removed and a split-thickness skin graft was applied. The defect had healed at the two-month follow-up. The patient now has normal erections and satisfactory sexual function.CONCLUSION Our experience with this wound repair demonstrated that the combination of a dermal regeneration template and a split-thickness skin graft with vacuumassisted closure is a safe, well-tolerated and efficient solution for the reconstruction of massive penoscrotal skin defects.展开更多
The use of skin flaps in reconstructive surgery is the first-line surgical treatment for the reconstruction of skin defects and is essentially considered the starting point of plastic surgery. Despite their excellent ...The use of skin flaps in reconstructive surgery is the first-line surgical treatment for the reconstruction of skin defects and is essentially considered the starting point of plastic surgery. Despite their excellent usability, their application includes general surgical risks or possible complications, the primary and most common is necrosis of the flap. To improve flap survival, researchers have used different methods, including the use of adiposederived stem cells, with significant positive results. In our research we will report the use of adipose-derived stem cells in pedicle skin flap survival based on current literature on various experimental models in animals.展开更多
Contaminated surfaces of the feedstock materials in aluminum alloy casting processes often produce various types of defects which can affect the tensile properties of the final products as well as their fatigue reliab...Contaminated surfaces of the feedstock materials in aluminum alloy casting processes often produce various types of defects which can affect the tensile properties of the final products as well as their fatigue reliabilities.Semi-solid processing takes advantage of a much higher apparent viscosity of the die cast materials by limiting the risk of oxides formed at the free surfaces to become incorporated into the casting when the material is injected into the die.Most of existing semi-solid processes that use billets as feedstock material are however tied up with a different type of contaminated surface.During the injection phase,the external-skin on the periphery of the billet,which has been in contact with air and lubricant during the transfer in the shot sleeve,can be incorporated into the casting.When subjected to a heat treatment,the lubricant is decomposed and produces lens shape porosities.This might be a cause of reject for most structural parts.To avoid this kind of defects,the paths along which the billet skin evolves must be controlled during filling.In order to investigate the possibility of skin inclusion into cast parts during injection of the billet,a two-phase finite element mixture model is employed to model the metal flow.The formation of a skin on the periphery of the billet is modeled by setting an initial solid phase concentration profile in the radial direction.Microscopic observations of the real castings show that the approach is able to model the shear layers and to predict the paths along which the"lens porosity"defects could be formed.An Arbitrary Eulerian-Lagangian(ALE) method is also investigated and appears to be very promising to follow the skin movement in the casting.展开更多
To treat large facial defect (more than 6 cm×4 cm in diameter ) or a wound with bone exposure to atmosphere by less traumatic, easier healing reconstruction method, a pedicle flap including facial, neck, poster...To treat large facial defect (more than 6 cm×4 cm in diameter ) or a wound with bone exposure to atmosphere by less traumatic, easier healing reconstruction method, a pedicle flap including facial, neck, posterior auricle and occipital skin flap was designed and transferred, one by one, to repair facial defect as well as other flap donor sites, but occipital skin flap was only used to cover posterior auricle area. After 2-3 years follow up, well healed skin flaps with good color, elasticity and sensation were observed in all 16 patients. It is concluded that this method is effective and practical.展开更多
AIM: To assess the use of a simple split skin graft harvesting technique, requiring only a scalpel and a swab.METHODS: During the last 8 mo, we operated on a consecutive series of 52 patients(30 males, 22 females) wit...AIM: To assess the use of a simple split skin graft harvesting technique, requiring only a scalpel and a swab.METHODS: During the last 8 mo, we operated on a consecutive series of 52 patients(30 males, 22 females) with a mean age of 60 years(33-80). We used the technique we present in order to cover small skin defects. All procedures were performed under local anesthesia. Thirty-seven patients underwent bedside surgery, 8 patients were operated on in the outpatient department and the remaining 7 had their graft harvested in the operating room. After antiseptic preparation of the donor site, the margins of the graft were drawn by the use of a surgical marker. A No 15 scalpel was used for the graft elevation, under constant traction with a moist swab.RESULTS: All procedures were completed successfully without immediate complications. The patients tolerated the procedure well. The mean operative time was 15 min. Twenty-four donor sites were left to heal by secondary intention, whereas 28 were sutured with interrupted 3/0 silk sutures in order to heal by primary intention. All 24 sites that were left to heal by secondary intention healed completely in approximately 14 d. For the sites that were sutured, the sutures were removed on the 10 th postoperative day. Out of the 52 operated cases, 6 patients(11%) developed complications. In 4 patients, the split thickness skin grafts were partially lost, whereas in 2 patients the grafts were completely lost. Wound dehiscence was observed in 2 patients, which were treated with local antiseptic and antibiotic therapy.CONCLUSION: The skin graft technique described is simple, costless and effective and can be performed even on an outpatient basis, without the need for special equipment.展开更多
Objective To study the effect of postoperative radiation on free skin flaps. Methods Twenty-nine patients with free skin flaps applied to the plerosis of the postoperative defect were followed up. Twenty-eight out of ...Objective To study the effect of postoperative radiation on free skin flaps. Methods Twenty-nine patients with free skin flaps applied to the plerosis of the postoperative defect were followed up. Twenty-eight out of 29 patients received forearm free flaps while 1 had anterolater-al femoris skin flaps in a size ranging from 14cm×6cm to 8cm×4cm. These flaps were exposed to 60Co radiation ranging 40-69 Gy. Results Observation during irradiation, no visible changes of skin flaps and oral mucous membrane were detected, when irradiation dose was within 40 Gy; some changes may be detected over 40 Gy. Observation 1 - 4 months after irradiation: pigmentations were found in areas of erosion epidermis; skin flaps got dark but without evidence of necrosis. Observation 2 years after irradiation, rib necrosis happened in 29 skin flaps. Hairs were found on 15 of 29 flaps. Sensation occurred within the margin of 1 cm. Conclusion Free skin flap can endure irradiation at the dose of 60 Gy.展开更多
文摘Objective:To investigate the effect of a subcutaneous pedicle Limberg flap for the reconstruction of medium-sized skin defects in the face following skin tumor or scar excision. Methods: From August 2002 to June 2004,the subcutaneous pedicle Limberg flap was designed to repair facial skin defects in 17 patients(19 flaps),and the size of the lesions ranged from 2.0 cm×1.9 cm to 5.0 cm×4.5 cm.The operation was performed under general anesthesia in 2 children,and under local anesthesia in the remaining 15 patients. Results: All flaps survived with primary healing postoperatively.With a follow-up from 1 to 22 months,neither short-term nor long-term postoperative complications such as flap necrosis,hematoma,infection,visible dog-ear and trap door deformity were found,and functionally and cosmetically satisfactory outcomes were achieved. Conclusion: This subcutaneous pedicle Limberg flap provides a competitive repair alternative for the treatment of medium-sized skin defects in the face.
文摘Objective: to analyze the clinical application effect of negative pressure sealing drainage (VSD) in skin defect complicated with infection wound. Methods: from June 2019 to June 2020, 39 cases of skin defect complicated with wound infection in our hospital were listed as the reference group, and 39 cases of the same type treated from June 2020 to June 2021 were listed as the analysis group. With reference to the traditional treatment method in group A, VSD was used in the analysis group after debridement, and the clinical treatment related indexes and the effective rate of wound treatment were compared between the two groups. Results: the use time of antibiotics in the treatment of patients in the comparative analysis group was significantly shorter than that in the reference group, and the wound area of patients in the treatment analysis group was significantly larger than that in the reference group, all of which were statistically verified (P<0.05). After treatment, the total effective rate of two groups of patients was counted. The total effective rate of the analysis group was significantly higher, being 100.00%(39/39), and that of the reference group was 79.49%(31/39). It was verified that P<0.05. Conclusion: compared with the traditional treatment methods, VSD has more advantages in treating skin defects complicated with infected wounds, which can reduce the use of antibiotics by patients and help to reduce the wound area. Its total effective rate is obviously higher, and it is easy to operate, so it can be popularized.
文摘Objective To introduce an effective reconstruction method for the finger injured with vessel and skin defect. Methods Free skin flap with skin vein was transplanted on the site of tissue defect, connecting by anastomosis the vein with artery or vein of the finger. Results Seven cases were treated with this method,among which 5 cases have sikin defect on the palm aspect of fingers, the rest have skin defect on the dorsal aspect skin of finger. All fingers survived with good shape and function. Conclusion This is a simple and effective method of finger reconstruction for the patients with defect of vessels and skin. 6 refs.
文摘To report a method of repair facial skin defects with a skin flap of SMAS pedicle.Methods According to the size of defect of skin,design a skin flap with SMAS pedicle for repair of defect.Results The method has been successfully applied for skin defects of eyelid and lip in 14 cases with satisfied results.The area of the largest flap was 5 cm×3 cm.Conclusion Repairing facial defects such as eyelid skin defect or lip skin defect with skin flap of SMAS pedicle is a very good method.The flap has a good blood supporting and satisfactory color and flexibility.5 refs,6 figs.
文摘In young patients, even small circular facial defects after the excision of benign skin tumors present a reconstructive challenge. The usefulness of a V-Y advancement flap for reconstructing such defects is well documented. We refined this technique as a mini V-Y advancement flap consisting of two subcutaneous pedicles that vascularize the skin island via subdermal plexus lateral bridges. This technique was used for 21 middle-aged or younger patients with a small benign skin lesion. None of them experienced any postoperative complications. Aesthetically excellent results were found in all patients. This small advancement flap could be attempted as an alternative to fusiform excision of small skin lesions, particularly in younger patients.
文摘The issue of skin defects is a major concern of almost every trauma surgeon after surgery. Despite numerous conventional methods and introduction of the reconstruction ladder, managing skin defects is still a challenge for the trauma surgeons. In recent years, parallel to the advances in the more conventional methods of skin repair, regenerative medicine has offered new and novel treatments. This article aims to explore these contemporary regenerative solutions as well as to review the conventional methods of treating skin defects.
文摘Background:Split-thickness skin grafting is the current gold standard for the treatment of traumatic skin loss.However,for patients with extensive burns,split-thickness skin grafting is limited by donor skin availability.Grafting split-thickness skin minced into micrografts increases the expansion ratio but may reduce wound repair quality.Dermal substitutes such as Pelnac can enhance the healing of full-thickness skin wounds,but their application currently requires two surgeries.The present study investigated whether it is possible to repair full-thickness skin defects and improve wound healing quality in a single surgery using Pelnac as an overlay of minced split-thickness skin grafts in a rat model.Methods:A full-thickness skin defect model was established using male Sprague-Dawley rats of 10 weeks old.The animals were randomly divided into control and experimental groups in which Vaseline gauze and Pelnac,respectively,were overlaid on minced split-thickness skin grafts to repair the defects.Wound healing rate and quality were compared between the two groups.For better illustration of the quality of wound healing,some results were compared with those obtained for normal skin of rats.Results:We found that using Pelnac as an overlay for minced split-thickness skin grafts accelerated wound closure and stimulated cell proliferation and tissue angiogenesis.In addition,this approach enhanced collagen synthesis and increased the formation of basement membrane and dermis as well as the expression of growth factors related to wound healing while reducing scar formation.Conclusions:Using minced split-thickness skin grafts overlaid with Pelnac enables the reconstruction of fullthickness skin defects in a single step and can increase the healing rate while improving the quality of wound healing.
基金Science Foundation of China(NO.92249303,NO.82230071,No.82172098,No.82371603)Jiangsu Province Natural Science and Technological Project(No.BK20231218)+4 种基金Experimental Animal Research Field Project Shanghai Science and Technology Commission(No.23141900600)Research Physician Innovation and Transformation Ability Training Project from Shanghai Health Commission(No.SHDC2023CRT013)Basic Medical Innovation Project of Changhai Hospital(No.20237Y38)Deep Blue Talent Project of Naval Medical University(Jin Cui)Shanghai Oriental Talent Program(Xiao Chen,Yuanyuan Liu).
文摘The healing of large skin defects remains a significant challenge in clinical settings.The lack of epidermal sources,such as autologous skin grafting,limits full-thickness skin defect repair and leads to excessive scar formation.Skin organoids have the potential to generate a complete skin layer,supporting in-situ skin regeneration in the defect area.In this study,skin organoid spheres,created with human keratinocytes,fibroblasts,and endothelial cells,showed a specific structure with a stromal core surrounded by surface keratinocytes.We selected an appropriate bioink and innovatively combined an extrusion-based bioprinting technique with dual-photo source cross-linking technology to ensure the overall mechanical properties of the 3D bioprinted skin organoid.Moreover,the 3D bioprinted skin organoid was customized to match the size and shape of the wound site,facilitating convenient implantation.When applied to full-thickness skin defects in immunodeficient mice,the 3D bioprinted human-derived skin organoid significantly accelerated wound healing through in-situ regeneration,epithelialization,vascularization,and inhibition of excessive inflammation.The combination of skin organoid and 3D bioprinting technology can overcome the limitations of current skin substitutes,offering a novel treatment strategy to address large-area skin defects.
基金the financial support provided by the National Natural Science Foundation of China(No.12103019)National Science and Technology Award Backup Project Cultivation Plan(No.20192AEI91007),China。
文摘Background and objectives Skin defects are one of the primary problems that occur in post-harvest grading and processing of loquats.Skin defects lead to the loquat being easily destroyed during transportation and storage,which causes the risk of other loquats being infected,affecting the selling price.Materials and Methods In this paper,a method combining band radio image with an improved three-phase level set segmentation algorithm(ITPLSSM)is proposed to achieve high accuracy,rapid,and non-destructive detection of skin defects of loquats.Principal component analysis(PCA)was used to find the characteristic wavelength and PC images to distinguish four types of skin defects.The best band ratio image based on characteristic wavelength was determined.Results The band ratio image(Q782/944)based on PC2 image is the best segmented image.Based on pseudo-color image enhancement,morphological processing,and local clustering criteria,the band ratio image(Q782/944)has better contrast between defective and normal areas in loquat.Finally,the ITPLSSM was used to segment the processing band ratio image(Q782/944),with an accuracy of 95.28%.Conclusions The proposed ITPLSSM method is effective in distinguishing four types of skin defects.Meanwhile,it also effectively segments images with intensity inhomogeneities.
基金Supported by National Natural Science Foundation of China,No.81702135Zhejiang Traditional Chinese Medicine Research Program,No.2016ZA124 and No.2017ZB057+1 种基金Zhejiang Medicine and Hygiene Research Program,No.2016KYB101 and No.2015KYA100Zhejiang Medical Association Clinical Scientific Research Program,No.2013ZYC-A19 and No.2015ZYC-A12
文摘BACKGROUND Although skin avulsions to male external genitalia are rare, they can be both physically and psychologically traumatic. Thus, the necessity for judicious management poses significant challenges to surgeons in order to avoid potential permanent disabilities. We report a case of massive penoscrotal skin avulsion and a composite graft was creatively applied to cover the defect which achieved good results. We believe that this case is of great reference value for fellow surgeons.CASE SUMMARY A 52-year-old male presented with massive traumatic avulsion of the penile and scrotal skin following mishandling of an electric drill. The avulsed skin was missing. The patient was diagnosed with massive skin avulsion of external genitalia. Following initial complete debridement of devitalized or infected tissues, Pelnac dermal substitute was secured to the defect with the assistance of negative-pressure wound closure. In the final step, the silicone layer of Pelnac was removed and a split-thickness skin graft was applied. The defect had healed at the two-month follow-up. The patient now has normal erections and satisfactory sexual function.CONCLUSION Our experience with this wound repair demonstrated that the combination of a dermal regeneration template and a split-thickness skin graft with vacuumassisted closure is a safe, well-tolerated and efficient solution for the reconstruction of massive penoscrotal skin defects.
文摘The use of skin flaps in reconstructive surgery is the first-line surgical treatment for the reconstruction of skin defects and is essentially considered the starting point of plastic surgery. Despite their excellent usability, their application includes general surgical risks or possible complications, the primary and most common is necrosis of the flap. To improve flap survival, researchers have used different methods, including the use of adiposederived stem cells, with significant positive results. In our research we will report the use of adipose-derived stem cells in pedicle skin flap survival based on current literature on various experimental models in animals.
文摘Contaminated surfaces of the feedstock materials in aluminum alloy casting processes often produce various types of defects which can affect the tensile properties of the final products as well as their fatigue reliabilities.Semi-solid processing takes advantage of a much higher apparent viscosity of the die cast materials by limiting the risk of oxides formed at the free surfaces to become incorporated into the casting when the material is injected into the die.Most of existing semi-solid processes that use billets as feedstock material are however tied up with a different type of contaminated surface.During the injection phase,the external-skin on the periphery of the billet,which has been in contact with air and lubricant during the transfer in the shot sleeve,can be incorporated into the casting.When subjected to a heat treatment,the lubricant is decomposed and produces lens shape porosities.This might be a cause of reject for most structural parts.To avoid this kind of defects,the paths along which the billet skin evolves must be controlled during filling.In order to investigate the possibility of skin inclusion into cast parts during injection of the billet,a two-phase finite element mixture model is employed to model the metal flow.The formation of a skin on the periphery of the billet is modeled by setting an initial solid phase concentration profile in the radial direction.Microscopic observations of the real castings show that the approach is able to model the shear layers and to predict the paths along which the"lens porosity"defects could be formed.An Arbitrary Eulerian-Lagangian(ALE) method is also investigated and appears to be very promising to follow the skin movement in the casting.
文摘To treat large facial defect (more than 6 cm×4 cm in diameter ) or a wound with bone exposure to atmosphere by less traumatic, easier healing reconstruction method, a pedicle flap including facial, neck, posterior auricle and occipital skin flap was designed and transferred, one by one, to repair facial defect as well as other flap donor sites, but occipital skin flap was only used to cover posterior auricle area. After 2-3 years follow up, well healed skin flaps with good color, elasticity and sensation were observed in all 16 patients. It is concluded that this method is effective and practical.
文摘AIM: To assess the use of a simple split skin graft harvesting technique, requiring only a scalpel and a swab.METHODS: During the last 8 mo, we operated on a consecutive series of 52 patients(30 males, 22 females) with a mean age of 60 years(33-80). We used the technique we present in order to cover small skin defects. All procedures were performed under local anesthesia. Thirty-seven patients underwent bedside surgery, 8 patients were operated on in the outpatient department and the remaining 7 had their graft harvested in the operating room. After antiseptic preparation of the donor site, the margins of the graft were drawn by the use of a surgical marker. A No 15 scalpel was used for the graft elevation, under constant traction with a moist swab.RESULTS: All procedures were completed successfully without immediate complications. The patients tolerated the procedure well. The mean operative time was 15 min. Twenty-four donor sites were left to heal by secondary intention, whereas 28 were sutured with interrupted 3/0 silk sutures in order to heal by primary intention. All 24 sites that were left to heal by secondary intention healed completely in approximately 14 d. For the sites that were sutured, the sutures were removed on the 10 th postoperative day. Out of the 52 operated cases, 6 patients(11%) developed complications. In 4 patients, the split thickness skin grafts were partially lost, whereas in 2 patients the grafts were completely lost. Wound dehiscence was observed in 2 patients, which were treated with local antiseptic and antibiotic therapy.CONCLUSION: The skin graft technique described is simple, costless and effective and can be performed even on an outpatient basis, without the need for special equipment.
基金Supported by the Scientific Develop-ment Foundation of Jiangsu Health(9717)
文摘Objective To study the effect of postoperative radiation on free skin flaps. Methods Twenty-nine patients with free skin flaps applied to the plerosis of the postoperative defect were followed up. Twenty-eight out of 29 patients received forearm free flaps while 1 had anterolater-al femoris skin flaps in a size ranging from 14cm×6cm to 8cm×4cm. These flaps were exposed to 60Co radiation ranging 40-69 Gy. Results Observation during irradiation, no visible changes of skin flaps and oral mucous membrane were detected, when irradiation dose was within 40 Gy; some changes may be detected over 40 Gy. Observation 1 - 4 months after irradiation: pigmentations were found in areas of erosion epidermis; skin flaps got dark but without evidence of necrosis. Observation 2 years after irradiation, rib necrosis happened in 29 skin flaps. Hairs were found on 15 of 29 flaps. Sensation occurred within the margin of 1 cm. Conclusion Free skin flap can endure irradiation at the dose of 60 Gy.
