Background: Foreign body granuloma is a rare late complication of fascia lata graft donor site with few reported cases in the literature. It can mimic soft tissue sarcoma. Clinical and radiological findings may not be...Background: Foreign body granuloma is a rare late complication of fascia lata graft donor site with few reported cases in the literature. It can mimic soft tissue sarcoma. Clinical and radiological findings may not be enough to solve the puzzle and histology remains the mainstay of diagnosis. Aim: Our aim is to highlight the unusual long interval between initial surgery and presentation of foreign body granuloma. Case Presentation: A 65-year-old man who presented 48 years after initial surgery with progressive painless fascia lata donor site soft tissue swelling. The management and histology findings were highlighted. Conclusion: The occurrence of foreign body granuloma remains an important differential following a history of past surgical procedure regardless of the time interval between the surgical procedure and the clinical presentation.展开更多
Background: Dressing of split-thickness skin graft donor sites can be traumatic for the patient. The most advanced and expensive dressings have been compared to the most basic of dressings, with little or no consensus...Background: Dressing of split-thickness skin graft donor sites can be traumatic for the patient. The most advanced and expensive dressings have been compared to the most basic of dressings, with little or no consensus and an unpersuasive level of evidence. We aimed to determine the efficacy of the locally manufactured non-adherent, hydroconductive Drawtex? dressing and compare it to our current standard-of-care dressing, a thin transparent polyurethane film, in the healing of split-thickness donor sites. Methods: This prospective, within-patient controlled study included 27 adult participants, each with two split-thickness skin donor sites. The 54 donor site wounds were compared with regard to time to re-epithelialisation, perceived pain and healed wound quality. Results: By day 5, complete healing of donor site wounds, defined as >90% of epithelialized surface, was significantly higher in the hydroconductive dressing group compared to the polyurethane film group (22.2% and 3.7%, respectively;p < 0.0001). The hydroconductive dressing-treated donor site wounds were significantly less painful at 24-hours, 48-hours and 7-days post-operatively, and had fewer complications and superior wound healing quality. Conclusion: We have demonstrated that the relatively cheap and readily available dressing made locally in South Africa, Drawtex? is at least as safe, and potentially superior in wound healing, when compared to our current standard-of-care dressing.展开更多
Background:Split skin grafting(SSG)is the cornerstone in the treatment of deep burns and large skin defects.Frequently used donor sites are the thigh,abdomen and buttocks.The scalp is less common while considered as a...Background:Split skin grafting(SSG)is the cornerstone in the treatment of deep burns and large skin defects.Frequently used donor sites are the thigh,abdomen and buttocks.The scalp is less common while considered as a reliable donor site.Advantages are a large surface area,rapid wound healing,cosmetically favourable results and multiple harvests from the same donor site.Complications include scab formation,chronic folliculitis and alopecia but have been recorded sporadically in previous studies.This article evaluates the complication rate of the scalp donor site in the treatment of deep burns in the Beverwijk Burn Centre.Methods:A retrospective study was performed of all patients who received a skin graft from the scalp at the Beverwijk Burn Centre between January 2004 and December 2012.Data were collected from medical files of included patients,including gender,age,type of burn(scald,flame,other)and total body surface area(TBSA)burned at the time of first surgery.Postoperative variables were healing time of the donor site and incidence of complications.During follow-up,the incidence of late complications was reviewed.Results:A total number of 105 grafts were analysed in 93 patients:58 males(62%)and 35 females(38%),with a median age of 2 years and 3 months old.Of the patients,30(32%)had flame burns and 57(61%)had scald burns.Eighty-seven percent of patients had a TBSA burned of 5%or less.All donor sites healed within 14 days.No alopecia or scar hypertrophy developed at the donor sites.Two patients(2.2%)developed folliculitis;one patient(1.1%)showed scab formation.Conclusions:The scalp as a donor site in our Burn Centre shows a comparable short-term complication rate to the previous literature,with quick healing and no long-term complications.Therefore,we propose the consideration of the scalp as a primary donor site,especially in young children,where the scalp offers a larger donor site area than the buttocks or thighs.展开更多
Background:Topical local analgesic and anaesthetic agents have been used both pre-and imme-diately post-harvest on split-thickness skin graft(STSG)donor site wounds(DSW).There is no systematic review of their effectiv...Background:Topical local analgesic and anaesthetic agents have been used both pre-and imme-diately post-harvest on split-thickness skin graft(STSG)donor site wounds(DSW).There is no systematic review of their effectiveness in providing post-harvest analgesia,or of the possible toxic effects of systemic absorption.This study is designed to address the question of which agent,if any,is favoured over the others and whether there are any safety data regarding their use.Methods:Systematic literature review of randomised controlled trials of topical agents applied to STSG DSWs,with a view to providing analgesia.Studies identified via search of Cochrane and EBSCO databases.No restrictions on language or publication year.Primary outcomes:pain at the time of(awake)STSG,and post-harvest pain(up to first dressing change).Secondary outcome was serum medication levels relative to published data on toxic doses.Cochrane risk of bias assessment tool utilised in assessment of included studies.At least 2 reviewers screened and reviewed included studies.A narrative review is presented.Results:There were 11 studies meeting inclusion criteria.Overall methodological quality and patient numbers were low.Topical eutectic mixture of lidocaine and prilocaine pre-harvest affords good local anaesthesia in awake STSG harvesting.Topical bupivacaine(5 studies)or lidocaine(1 study)gave significantly better post-harvest anaesthesia/analgesia than placebo.Topical morphine performs no better than placebo.Topical local anaesthetic agents at reported doses were all well below toxic serum levels.Conclusions:Topical local anaesthetics(lidocaine or bupivacaine)provide good analgesia,both during and after STSG harvest,at well below toxic serum levels,but there are no good data determining the best local anaesthetic agent to use.There is no evidence morphine performs better than placebo.展开更多
Aim:Traditional donor site closure from radial forearm free flap(RFFF)has been associated with esthetic and functional morbidity.To avoid complications,such as color mismatch and secondary donor site morbidity,a new t...Aim:Traditional donor site closure from radial forearm free flap(RFFF)has been associated with esthetic and functional morbidity.To avoid complications,such as color mismatch and secondary donor site morbidity,a new technique named‘‘Iberic graft’’for covering the RFFF donor site was described previously by our team.Methods:A study of patients who underwent reconstruction of head and neck defects using a RFFF was conducted to assess postoperative complications of the RFFF donor site and also to evaluate the morbidity in terms of aesthetics and function following the use of the“Iberic graft”.The donor site was covered by the use of a combined local triangular full-thickness skin graft.Color match,quality of the scar,presence of necrosis,dehiscence of the suture or tendon exposure were recorded and analyzed.Results:One hundred and twenty-five consecutive patients undergoing RFFF harvesting were included.RFFF donor site defects ranged from 15 cm2 to 70 cm2;9 patients(7%)had small dehiscences of the forearm skin graft,whereas 2 cases(1.6%)presented tendon exposure.Otherwise,partial skin graft loss occurred in a few patients.In all cases,these sites healed secondarily by conservative management,with no final impairment of function.Assessment of the forearm donor site at 1 to 3 months after the primary surgical procedure showed complete defect coverage,good color match,and no scarring along the graft line.Conclusion:The“Iberic graft”is a reliable method for closing most of RFFF donor site defects as it provides excellent color match and pliability,while obviates the need for a second surgical site.展开更多
There exists a single nucleotide polymorphism, G or T, at the first base of the donor splice site of waxy gene intron 1 in rice. In order to study the relationship between the first base of the donor splice site of wa...There exists a single nucleotide polymorphism, G or T, at the first base of the donor splice site of waxy gene intron 1 in rice. In order to study the relationship between the first base of the donor splice site of waxy gene intron 1 and amylose content in rice, the one-step PCR method was used to determine whether it is G or T in 220 Yunnan indigenous rice varieties from 14 districts, 55 towns/counties of Yunnan Province, and 101 varieties of which were validated by the PCR-Acc I method. According to the G/T polymorphism, 164 rice varieties showed GG-genotype, while the other 56 fell into TT- genotype, accounting for 74.5% and 25.5% of all the test varieties, respectively. When all the rice varieties were divided into indica and japonica subspecies, it was found that 80.5% of indica rice and 67.0% of japonica rice belonged to GG-genotype. The rice varieties with GG-genotype had significantly higher amylose content （18.95% on average） than those with TT- genotype （all below 16%）, but 33 rice varieties with GG-genotype still had low amylose content ranging from 3.91% to 15.93%, and most of them came from the Dai minority area in the Southwest of Yunnan Province. However, there was no significant difference in the mean amylose content of the same GG or TT genotypes between indica and japonica rice, suggesting that different genetic backgrounds, indica or japonica, had no effect on amylose content. The coefficient of correlation between the genotype and amylose content was 0.733 （P〈0.01）.展开更多
AIM: To investigate donor site's area histological and immunohistochemical knee cartilage appearances after resurfacing iatrogenic defects with biosynthetic plugs orautografts. METHODS: Thirty New Zealand White ra...AIM: To investigate donor site's area histological and immunohistochemical knee cartilage appearances after resurfacing iatrogenic defects with biosynthetic plugs orautografts. METHODS: Thirty New Zealand White rabbits were used in this study. A full-thickness cylindrical defect of 4.5 mm(diameter) × 7 mm(depth) was created with a hand drill in the femoral groove of every animal. In Group A(n = 10) the defect of the donor site was re-paired with a biosynthetic osteochondral plug, in Group B(n = 10) with an osteochondral autograft, while in Group C(control group of 10) rabbits were left untreated. RESULTS: Twenty-four weeks postoperatively, smooth articular cartilage was found macroscopically in some trocleas' surfaces; in all others, an articular surface with discontinuities was observed. Twenty-eight out of 30 animals were found with predominantly viable chondrocytes leaving the remaining two-which were found only in the control group- with partially viable chondrocytes. However, histology revealed many statistical differences between the groups as far as the International Cartilage Repair Society(ICRS) categories are concerned. Immunofluoresence also revealed the presence of collagen Ⅱ in all specimens of Group B, whereas in Group A collagen Ⅱ was found in less specimens. In Group C collagen Ⅱwas not found. CONCLUSION: The matrix, cell distribution, subchondral bone and cartilage mineralization ICRS categories showed statistically differences between the three groups. Group A was second, while group B received the best scores; the control group got the worst ICRS scores in these categories. So, the donor site area, when repairing osteochondral lesions with autografting systems, is better amended with osteochondral autograft rather than bone graft substitute implant.展开更多
Full thickness skin grafts and composite grafts are a workhorse in reconstructive surgery of nose and ear defects whether they are originated from trauma, cancer surgery or burns. The reliability of these grafts has b...Full thickness skin grafts and composite grafts are a workhorse in reconstructive surgery of nose and ear defects whether they are originated from trauma, cancer surgery or burns. The reliability of these grafts has been proved with an established clinical use and morbidity to the donor site is minimal if harvesting and donor site selection if appropriate. Use of double or multiple grafts to reconstruct a complex defect of the nose has not been described and our report is meaningful for the fact that it describes a further use of the surgical concept of grafting.展开更多
文摘Background: Foreign body granuloma is a rare late complication of fascia lata graft donor site with few reported cases in the literature. It can mimic soft tissue sarcoma. Clinical and radiological findings may not be enough to solve the puzzle and histology remains the mainstay of diagnosis. Aim: Our aim is to highlight the unusual long interval between initial surgery and presentation of foreign body granuloma. Case Presentation: A 65-year-old man who presented 48 years after initial surgery with progressive painless fascia lata donor site soft tissue swelling. The management and histology findings were highlighted. Conclusion: The occurrence of foreign body granuloma remains an important differential following a history of past surgical procedure regardless of the time interval between the surgical procedure and the clinical presentation.
文摘Background: Dressing of split-thickness skin graft donor sites can be traumatic for the patient. The most advanced and expensive dressings have been compared to the most basic of dressings, with little or no consensus and an unpersuasive level of evidence. We aimed to determine the efficacy of the locally manufactured non-adherent, hydroconductive Drawtex? dressing and compare it to our current standard-of-care dressing, a thin transparent polyurethane film, in the healing of split-thickness donor sites. Methods: This prospective, within-patient controlled study included 27 adult participants, each with two split-thickness skin donor sites. The 54 donor site wounds were compared with regard to time to re-epithelialisation, perceived pain and healed wound quality. Results: By day 5, complete healing of donor site wounds, defined as >90% of epithelialized surface, was significantly higher in the hydroconductive dressing group compared to the polyurethane film group (22.2% and 3.7%, respectively;p < 0.0001). The hydroconductive dressing-treated donor site wounds were significantly less painful at 24-hours, 48-hours and 7-days post-operatively, and had fewer complications and superior wound healing quality. Conclusion: We have demonstrated that the relatively cheap and readily available dressing made locally in South Africa, Drawtex? is at least as safe, and potentially superior in wound healing, when compared to our current standard-of-care dressing.
文摘Background:Split skin grafting(SSG)is the cornerstone in the treatment of deep burns and large skin defects.Frequently used donor sites are the thigh,abdomen and buttocks.The scalp is less common while considered as a reliable donor site.Advantages are a large surface area,rapid wound healing,cosmetically favourable results and multiple harvests from the same donor site.Complications include scab formation,chronic folliculitis and alopecia but have been recorded sporadically in previous studies.This article evaluates the complication rate of the scalp donor site in the treatment of deep burns in the Beverwijk Burn Centre.Methods:A retrospective study was performed of all patients who received a skin graft from the scalp at the Beverwijk Burn Centre between January 2004 and December 2012.Data were collected from medical files of included patients,including gender,age,type of burn(scald,flame,other)and total body surface area(TBSA)burned at the time of first surgery.Postoperative variables were healing time of the donor site and incidence of complications.During follow-up,the incidence of late complications was reviewed.Results:A total number of 105 grafts were analysed in 93 patients:58 males(62%)and 35 females(38%),with a median age of 2 years and 3 months old.Of the patients,30(32%)had flame burns and 57(61%)had scald burns.Eighty-seven percent of patients had a TBSA burned of 5%or less.All donor sites healed within 14 days.No alopecia or scar hypertrophy developed at the donor sites.Two patients(2.2%)developed folliculitis;one patient(1.1%)showed scab formation.Conclusions:The scalp as a donor site in our Burn Centre shows a comparable short-term complication rate to the previous literature,with quick healing and no long-term complications.Therefore,we propose the consideration of the scalp as a primary donor site,especially in young children,where the scalp offers a larger donor site area than the buttocks or thighs.
文摘Background:Topical local analgesic and anaesthetic agents have been used both pre-and imme-diately post-harvest on split-thickness skin graft(STSG)donor site wounds(DSW).There is no systematic review of their effectiveness in providing post-harvest analgesia,or of the possible toxic effects of systemic absorption.This study is designed to address the question of which agent,if any,is favoured over the others and whether there are any safety data regarding their use.Methods:Systematic literature review of randomised controlled trials of topical agents applied to STSG DSWs,with a view to providing analgesia.Studies identified via search of Cochrane and EBSCO databases.No restrictions on language or publication year.Primary outcomes:pain at the time of(awake)STSG,and post-harvest pain(up to first dressing change).Secondary outcome was serum medication levels relative to published data on toxic doses.Cochrane risk of bias assessment tool utilised in assessment of included studies.At least 2 reviewers screened and reviewed included studies.A narrative review is presented.Results:There were 11 studies meeting inclusion criteria.Overall methodological quality and patient numbers were low.Topical eutectic mixture of lidocaine and prilocaine pre-harvest affords good local anaesthesia in awake STSG harvesting.Topical bupivacaine(5 studies)or lidocaine(1 study)gave significantly better post-harvest anaesthesia/analgesia than placebo.Topical morphine performs no better than placebo.Topical local anaesthetic agents at reported doses were all well below toxic serum levels.Conclusions:Topical local anaesthetics(lidocaine or bupivacaine)provide good analgesia,both during and after STSG harvest,at well below toxic serum levels,but there are no good data determining the best local anaesthetic agent to use.There is no evidence morphine performs better than placebo.
文摘Aim:Traditional donor site closure from radial forearm free flap(RFFF)has been associated with esthetic and functional morbidity.To avoid complications,such as color mismatch and secondary donor site morbidity,a new technique named‘‘Iberic graft’’for covering the RFFF donor site was described previously by our team.Methods:A study of patients who underwent reconstruction of head and neck defects using a RFFF was conducted to assess postoperative complications of the RFFF donor site and also to evaluate the morbidity in terms of aesthetics and function following the use of the“Iberic graft”.The donor site was covered by the use of a combined local triangular full-thickness skin graft.Color match,quality of the scar,presence of necrosis,dehiscence of the suture or tendon exposure were recorded and analyzed.Results:One hundred and twenty-five consecutive patients undergoing RFFF harvesting were included.RFFF donor site defects ranged from 15 cm2 to 70 cm2;9 patients(7%)had small dehiscences of the forearm skin graft,whereas 2 cases(1.6%)presented tendon exposure.Otherwise,partial skin graft loss occurred in a few patients.In all cases,these sites healed secondarily by conservative management,with no final impairment of function.Assessment of the forearm donor site at 1 to 3 months after the primary surgical procedure showed complete defect coverage,good color match,and no scarring along the graft line.Conclusion:The“Iberic graft”is a reliable method for closing most of RFFF donor site defects as it provides excellent color match and pliability,while obviates the need for a second surgical site.
文摘There exists a single nucleotide polymorphism, G or T, at the first base of the donor splice site of waxy gene intron 1 in rice. In order to study the relationship between the first base of the donor splice site of waxy gene intron 1 and amylose content in rice, the one-step PCR method was used to determine whether it is G or T in 220 Yunnan indigenous rice varieties from 14 districts, 55 towns/counties of Yunnan Province, and 101 varieties of which were validated by the PCR-Acc I method. According to the G/T polymorphism, 164 rice varieties showed GG-genotype, while the other 56 fell into TT- genotype, accounting for 74.5% and 25.5% of all the test varieties, respectively. When all the rice varieties were divided into indica and japonica subspecies, it was found that 80.5% of indica rice and 67.0% of japonica rice belonged to GG-genotype. The rice varieties with GG-genotype had significantly higher amylose content （18.95% on average） than those with TT- genotype （all below 16%）, but 33 rice varieties with GG-genotype still had low amylose content ranging from 3.91% to 15.93%, and most of them came from the Dai minority area in the Southwest of Yunnan Province. However, there was no significant difference in the mean amylose content of the same GG or TT genotypes between indica and japonica rice, suggesting that different genetic backgrounds, indica or japonica, had no effect on amylose content. The coefficient of correlation between the genotype and amylose content was 0.733 （P〈0.01）.
文摘AIM: To investigate donor site's area histological and immunohistochemical knee cartilage appearances after resurfacing iatrogenic defects with biosynthetic plugs orautografts. METHODS: Thirty New Zealand White rabbits were used in this study. A full-thickness cylindrical defect of 4.5 mm(diameter) × 7 mm(depth) was created with a hand drill in the femoral groove of every animal. In Group A(n = 10) the defect of the donor site was re-paired with a biosynthetic osteochondral plug, in Group B(n = 10) with an osteochondral autograft, while in Group C(control group of 10) rabbits were left untreated. RESULTS: Twenty-four weeks postoperatively, smooth articular cartilage was found macroscopically in some trocleas' surfaces; in all others, an articular surface with discontinuities was observed. Twenty-eight out of 30 animals were found with predominantly viable chondrocytes leaving the remaining two-which were found only in the control group- with partially viable chondrocytes. However, histology revealed many statistical differences between the groups as far as the International Cartilage Repair Society(ICRS) categories are concerned. Immunofluoresence also revealed the presence of collagen Ⅱ in all specimens of Group B, whereas in Group A collagen Ⅱ was found in less specimens. In Group C collagen Ⅱwas not found. CONCLUSION: The matrix, cell distribution, subchondral bone and cartilage mineralization ICRS categories showed statistically differences between the three groups. Group A was second, while group B received the best scores; the control group got the worst ICRS scores in these categories. So, the donor site area, when repairing osteochondral lesions with autografting systems, is better amended with osteochondral autograft rather than bone graft substitute implant.
文摘Full thickness skin grafts and composite grafts are a workhorse in reconstructive surgery of nose and ear defects whether they are originated from trauma, cancer surgery or burns. The reliability of these grafts has been proved with an established clinical use and morbidity to the donor site is minimal if harvesting and donor site selection if appropriate. Use of double or multiple grafts to reconstruct a complex defect of the nose has not been described and our report is meaningful for the fact that it describes a further use of the surgical concept of grafting.
