Use of split-thickness plantar skin grafts in the management of leg and foot skin defects

Split-thickness Plantar Skin Graft for Foot Syndactyly

For the treatment of syndactyly, the submalleolar or inguinal area is the common donor site for skin grafts. However, high skin tension of the submalleolar area could potentially delay wound healing or cause scarring. Skin grafts from the inguinal area cause pigmentation. In this study, we have harvested split-thickness skin grafts from the plantar area to treat syndactyly and evaluated the healing course and aesthetic outcome. We analyzed 13 recipient and nine donor sites in eight patients, aged 13-68 months (average 25 months), with syndactyly of the foot. The minimum follow-up was 14 months, and average follow-up period was 22.3 months. Aesthetic outcomes including color and texture match, wound healing of donor site using Vancouver Scar Scale, and complications of both sites were assessed in all patients. At the recipient sites, the graft survived well, and the lack of pigmentation of the graft led to good color match. At the donor sites, hypertrophic scar and high scar scale were seen around postoperative month 3, but were momentary, as all donor sites matured to a flat and soft scar. Morbidity of split-thickness skin graft from the plantar region is limited. It causes minimum scarring of the nonexposed area. Moreover, because it does not cause pigmentation, the split-thickness skin graft technique is a reasonable option for the treatment of syndactyly.

Reconstructive Techniques in Melanoma for the Surgical Oncologist

Wounds resulting from wide local excision of melanoma vary in size and complexity, and require individualized solutions to achieve satisfactory closure. Goals of reconstruction include restoration of form, function, and aesthetics while minimizing donor site morbidity without compromising the effectiveness and safety of oncologic melanoma treatment. Optimal reconstruction relies on an in-depth understanding of the defect, locoregional anatomy and vasculature, available donor tissues, and basic wound healing and surgical principles. This article provides a broad overview of preoperative patient, timing, and wound considerations; various surgical techniques for complex reconstruction throughout the body; and postoperative care and complication management.

[Superficial circumflex iliac artery perforator free flap in pediatric reconstruction: A case report]

The dorsalis pedis reconstruction requires to bring a thin tissue to recover every noble structure of the foot including tendons, nerves and vessels while resisting the stress induced on these structures when walking or wearing shoes. We report the case of a thirteen year-old child who presented a third-degree burn sequelae on the dorsalis pedis with scar retraction and chronic ulceration on the fifth metatarsal despite multiple skin grafts. He couldn't put on his shoes because of the pain and walking was difficult. We performed a SCIP flap (Superficial Circumflex Iliac Artery Perforator) to reconstruct this defect. The flap measuring 12×7cm has been harvested on the right groin and anastomosed with the pedicle of the first intermetatarsal space. At 3 months postoperatively, the child can put on his shoes again and walk without pain. The donor site is discrete in the inguinal crease, hidden in the underwear. The SCIP flap is a thin and pliable flap with a discrete donor site. It is suitable for reconstructions of distal extremities of limbs, both in adults and children.

Use of split-thickness plantar skin grafts in the management of leg and foot skin defects

The basic principle of donor site selection is to take skin from areas that will heal with minimal scarring while balancing the needs of the recipient site. For skin loss from the lower legs and feet, the most common harvest site for split-thickness skin grafts is the anterior or posterior thigh; grafts from the plantar areas have been mostly used to cover the volar aspect of digits and palms. Between September 2015 and September 2017, 42 patients with areas of skin loss on the legs or feet were treated with plantar skin grafts because of their cosmetic benefits and the convenience of the surgical procedure and postoperative wound care. Our technique of harvesting a single layer of split-thickness skin graft (0.014 in. thick) from a non-weight-bearing area of the foot of the injured leg is simple and provided good functional and cosmetic outcomes at both the donor and recipient sites. All patients were very satisfied with the recovery progress and final results. Therefore, in the management of skin defects in the lower legs or feet that comprise less than 1.5% of the total body surface area, our surgical method is a reliable alternative to anterior or posterior thigh skin grafting.