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Fulltext Fournier's gangrene and the use of preputial rotation graft

Krishnan MMS

Med J Malaysia, 1982 Jun;37(2):124-7.
PMID: 6752671

This paper presents four cases of Fournier's gangrene, including one involving a reconstructive procedure using a preputial rotation flap to cover the raw area, to reduce the period of wound healing. Since Fournier's description of Idiopathic scrotal gangrene in 1884, there have been a number of reports on this relatively rare disease but the problem of achieving early healing and epithelialisation remains.

Matched MeSH terms: Skin Transplantation*
Successful free omental flap and skin graft reconstruction of scalp avulsion injury

Ramzisham AR, Somasundaram S, Nasir ZM, Ali F, Das S

Clin Ter, 2010;161(5):453-5.
PMID: 20949243

For the management of a full-thickness scalp avulsion injury, thorough wound debridement and immediate primary revascularization or a split-thickness skin graft may be necessary. Graft failure may be common situation thereby predisposing the individuals to unnecessary multiple operations. In the recent times, the use of omental graft has gained much popularity. In the present study, we describe an interesting case of chronic non healing scalp ulcer in a young woman who eventually underwent a free omental flap reconstruction with split-thickness skin graft and had satisfactory outcome.

Matched MeSH terms: Skin Transplantation*
Outcome of the Modified Meek Technique in the Management of Major Pediatric Burns

Lee SZ, Halim AS, Wan Sulaiman WA, Mat Saad AZ

Ann Plast Surg, 2018 09;81(3):295-301.
PMID: 29994880 DOI: 10.1097/SAP.0000000000001565

INTRODUCTION: The modified Meek micrografting technique has been used in the treatment of severely burned patients and a number of articles have examined the use of the modified Meek technique in adults and in mixed-age groups. However, there is a paucity of research pertaining to the outcome in the pediatric age group. The aim of this study is to present our favorable outcome in pediatric major burns using the modified Meek technique.
METHODS: A retrospective review of burn cases in Hospital Universiti Sains Malaysia from 2010 to 2015 was conducted. Cases of major burns among pediatric patients grafted using the Meek technique were examined.
RESULTS: Twelve patients were grafted using the Meek technique. Ten (91.7%) patients were male, whereas 2 (8.3%) were female. The average age of patients was 6 years (range, 2-11 years). The average total body surface area was 35.4% (range, 15%-75%). Most burn mechanisms were due to flame injury (66.7%) as compared with scalds injury (16.7%) and chemical injury (16.7%). There was no mortality. All patients were completely grafted with a good donor site scar. The average graft take rate was 82.3%, although 8 cases had positive tissue cultures from the Meek-grafted areas. The average follow-up duration was 3.6 years (range, 1.1-6.7 years). Only 1 case developed contracture over minor joint.
CONCLUSIONS: The Meek technique is useful when there is a paucity of donor site in the pediatric group. The graft take is good, contracture formation is low, and this technique is cost-effective.

Matched MeSH terms: Skin Transplantation/methods*
Anticipating local flaps closed-form solution on 3D face models using finite element method

Kwan Z, Khairu Najhan NN, Yau YH, Luximon Y, M Nor F

Int J Numer Method Biomed Eng, 2020 11;36(11):e3390.
PMID: 32735083 DOI: 10.1002/cnm.3390

A realistic three-dimensional (3D) computational model of skin flap closures using Asian-like head templates from two different genders, male and female, has been developed. The current study aimed to understand the biomechanics of the local flap designs along with the effect of wound closures on the respective genders. Two Asian head templates from opposite genders were obtained to use as base models. A third-order Yeoh hyperelastic model was adapted to characterize as skin material properties. A single layer composed of combined epidermis and dermis was considered, and the models were thickened according to respective anatomical positions. Each model gender was excised with a fixed defect size which was consequently covered by three different local flap designs, namely advancement, rotation, and rhomboid flaps. Post-operative simulation presented various scenarios of skin flap closures. Rotation and rhomboid flaps demonstrated maximal tension at the apex of the flap for both genders as well as advancement flap in the female face model. However, advancement flap closure in the male face model was presented otherwise. Yet, the deformation patterns and the peak tension of the discussed flaps were consistent with conventional local flap surgery. Moreover, male face models generated higher stresses compared to the female face models with a 70.34% mean difference. Overall, the skin flap operations were executed manually, and the designed surgery model met the objectives successfully while acknowledging the study limitations. NOVELTY FILE: 3D head templates were considered to address the gap as 3D face models were uncommonly employed in understanding the biomechanics of the local flaps realistically. Most of the existing studies focus on the 2D and 3D planar geometry in their models. As gender comparison has yet to be addressed, we intended to fill this gap by exploring the stress contours of the local flap designs in different genders. Create a 3D face model from two opposite genders which is capable of simulating closure of wounds using local flaps with a focus on advancement, rotation, and rhomboid flaps.

Matched MeSH terms: Skin Transplantation*
Fulltext Omental transposition flap and split skin graft for locally advanced breast carcinoma

Lee SH, Cheah DS, Krishnan MM

Singapore Med J, 1990 Jun;31(3):217-20.
PMID: 2392698

Locally advanced or recurrent carcinoma of the breast poses difficult management problems. These fungating and discharging tumours severely impair the quality of life in these unfortunate patients. We report two cases successfully treated with omental transposition flaps and split skin grafts. The operation is described in detail and the results discussed. This technique was found to be safe, effective and rewarding.

Matched MeSH terms: Skin Transplantation*
Fulltext Low-grade liquid silicone injections as a penile enhancement procedure: Is bigger better?

Sasidaran R, Zain MA, Basiron NH

Urol Ann, 2012 Sep;4(3):181-6.
PMID: 23248528 DOI: 10.4103/0974-7796.102672

To report our experience with 5 cases of complications of penile enhancement procedures secondary to liquid silicone injections and our method of management of its debilitating effects. All five patients were treated with excision of penile shaft skin down to buck's fascia followed by resurfacing with split thickness skin grafting. We conclude that penile enhancement procedures with liquid silicone by non-medical personnel could result in devastating consequences. We also demonstrate that a simple method of excision of the entire penile shaft skin and resurfacing with split skin grafting showed improvement in cosmetic as well as functional outcome.

Matched MeSH terms: Skin Transplantation
Fulltext Reconstruction options following wide excision of basal cell carcinoma of the face

Khoo, Hau Chun, Enda Gerard, Kelly, Mohd Ali Mat Zain, Farrah-Hani Imran

Journal of Surgical Academia, 2015;5(2):70-74.
MyJurnal

Basal cell carcinoma is the commonest skin malignancy diagnosed in Malaysia. Surgery is the recommended treatment of choice with the lowest failure rate provided a clear margin is obtained. However, the defect may be too large to be repaired primarily. Formal reconstruction using grafts and flaps should be done to achieve the optimal aim of maintaining the integrity, function and cosmetic patient outcome. Three reconstructive methods are described in this series to restore the facial defect following the wide local excision. The procedures described were peri-alar crescentic advancement flap, nasolabial rotational flap and full thickness skin graft using supraclavicular skin. This series highlights the usage of the procedures based on solid foundation and principles, without compromising the desired outcomes for the patient.

Matched MeSH terms: Skin Transplantation
Fulltext Reconstruction of Secondary Type Congenital Hallux Varus with Modification of the Farmer Technique for Cover of Skin Defect: Report of Three Cases

Sulaiman AR, Munajat I, M-Yusuf H, Nik-Jaffar N, Zarullail NH, Mohd EF, et al.

Malays Orthop J, 2019 Nov;13(3):72-76.
PMID: 31890115 DOI: 10.5704/MOJ.1911.013

The reconstruction of hallux varus deformity involves the release of contracted medial structure and realignment of the phalange, leaving a significant skin defect which requires cover. Farmer described proximal based rotational skin flap from the first web space to cover the defect. This technique may compromise the circulation to the flap and risk to the lateral digital vessels. We modified his technique to address these issues. We report a successful reconstruction using the Farmer's technique on one patient and a modified technique on three patients. We used the excess skin from the extra digit to cover the medial defect. We found this modified technique of skin cover safe without risk of injuring the neurovascular bundle. There was no recurrence of deformity at last foolow-up. All patients were able to wear normal shoes.

Matched MeSH terms: Skin Transplantation
Use of dermal regeneration template (INTEGRA) in reconstructive burn surgery

Sasidaran R, Dorai AA, Sulaiman WA, Halim AS

Med J Malaysia, 2008 Jul;63 Suppl A:29.
PMID: 19024967

We present our two year experience with a dermal regeneration template (INTEGRA) in burn reconstructive surgery for contracture release as well as a reconstructive tool for management of soft tissue loss.

Matched MeSH terms: Skin Transplantation/instrumentation*; Skin Transplantation/methods
Usage of allogeneic single layered tissue engineered skin enhance wound treatment in sheep

Adha PR, Chua KH, Mazlyzam AL, Low KC, Aminuddin BS, Ruszymah BH

Med J Malaysia, 2008 Jul;63 Suppl A:30-1.
PMID: 19024968

A major factor limiting survival following extensive thermal injury is insufficient availability of donor sites to provide enough skin for the required grafting procedures. Limitation of autologous grafting promotes the usage of allograft skin substitutes to promote wound healing. Here, we investigated the wound healing potential of allograft single layered tissue engineered skin which comprises of either keratinocytes (SLTES-K) or fibroblast (SLTES-F) with fibrin as the delivery system. Results from gross and microscopic evaluation showed our single layered tissue engineered skin constructed with keratinocytes or fibroblast after gamma radiation with the dosage of 2Gy could serve as allograft for the treatment of skin loss.

Matched MeSH terms: Skin Transplantation/instrumentation*; Skin Transplantation/methods
Effect of keratin-gelatin and bFGF-gelatin composite film as a sandwich layer for full-thickness skin mesh graft in experimental dogs

Thilagar S, Jothi NA, Omar AR, Kamaruddin MY, Ganabadi S

J Biomed Mater Res B Appl Biomater, 2009 Jan;88(1):12-6.
PMID: 18161832

Skin grafts are indicated when there is a major loss of skin. Full-thickness skin graft is an ideal choice to reconstruct defect of irregular surface that is difficult to immobilize. Full-thickness mesh grafts can be applied to patch large skin defect when there is less donor site in extensively traumatized and burned surgical patients. The concept of using natural biomaterials such as keratin, basic fibroblast growth factor is slowly gaining popularity in the field of medical research to achieve early healing. The main objective of this study is to evaluate the efficacy of gelatin conjoined with keratin processed from the poultry feather and commercially available basic fibroblast growth factor (bFGF) as a sandwich layer in promoting the viability of full-thickness skin mesh grafts. The efficacy was assessed from the observation of clinical, bacteriological, and histopathological findings in three groups of experimental dogs. The clinical observations such as color, appearance and discharge, and hair growth were selected as criteria which indicated good and early acceptance of graft in keratin-gelatin (group II). On bacteriological examination, Staphylococcus aureus and Proteus was identified in few animals. Histopathological study of the patched graft revealed early presences of hair follicles; sebaceous gland, and normal thickness of the epidermis in keratin-gelatin in group II treated animals compared with other group (group I-control, group III-bFGF-gelatin).

Matched MeSH terms: Skin Transplantation/instrumentation*; Skin Transplantation/methods
Fulltext Modified vacuum-assisted closure

Sia, S.F., Fong, E.P.

JUMMEC, 2006;9(2):24-27.
MyJurnal

The treatment of large ulcers is a problem. Closure with flaps and even skin grafts in compromised patients is often fraught with risks. Dressing these large wounds is also a problem, as they are often heavily exudative. We report our experience using the vacuum-assisted closure technique in managing difficult ulcers in four patients. A modification of the technique using cheap, easily available materials is described. The vacuum-assisted suction is an effective treatment for large ulcers in compromised patients. It facilitates considerable contraction of the wound, and in smaller wounds; the vacuum-assisted closure allows sufficient contracture to enable delayed primary closure. We recommend the use of this method of wound dressing and closure in large wounds particularly, in high-risk patients where extensive flap coverage or even split skin graft would incur considerable risk.

Matched MeSH terms: Skin Transplantation
Fulltext Encapsulation and Characterization of Gentamicin Sulfate in the Collagen Added Electrospun Nanofibers for Skin Regeneration

Abdul Khodir WKW, Abdul Razak AH, Ng MH, Guarino V, Susanti D

J Funct Biomater, 2018 May 18;9(2).
PMID: 29783681 DOI: 10.3390/jfb9020036

In the current practice, the clinical use of conventional skin substitutes such as autogenous skin grafts have shown several problems, mainly with respect to limited sources and donor site morbidity. In order to overcome these limitations, the use of smart synthetic biomaterials is tremendously diffusing as skin substitutes. Indeed, engineered skin grafts or analogues frequently play an important role in the treatment of chronic skin wounds, by supporting the regeneration of newly formed tissue, and at the same time preventing infections during the long-term treatment. In this context, natural proteins such as collagen-natively present in the skin tissue-embedded in synthetic polymers (i.e., PCL) allow the development of micro-structured matrices able to mimic the functions and to structure of the surrounding extracellular matrix. Moreover, the encapsulation of drugs, such as gentamicin sulfate, also improves the bioactivity of nanofibers, due to the efficient loading and a controlled drug release towards the site of interest. Herein, we have done a preliminary investigation on the capability of gentamicin sulfate, loaded into collagen-added nanofibers, for the controlled release in local infection treatments. Experimental studies have demonstrated that collagen added fibers can be efficaciously used to administrate gentamicin for 72 h without any toxic in vitro response, thus emerging as a valid candidate for the therapeutic treatment of infected wounds.

Matched MeSH terms: Skin Transplantation
The effect of a small triangular skin flap on vermillion height after cleft lip repair: a photogrammetry study

Wong LS, Lu TC, Chen PK

Int J Oral Maxillofac Surg, 2019 Oct;48(10):1313-1316.
PMID: 30898431 DOI: 10.1016/j.ijom.2019.02.021

During primary cleft lip repair, a small triangular flap of about 2mm is sometimes required to achieve better symmetry of Cupid's bow. The aim of this study was to evaluate the symmetry of Cupid's bow, with and without the use of a small triangular skin flap (STSF). Forty-five children who underwent the repair of unilateral cleft lip between January 1999 and December 2000 were recruited. Twenty children had a STSF included in the repair (STSF group) an d 25 children underwent the same repair without the STSF (NSTSF group). Vermillion height was measured on the cleft and non-cleft sides using reference points. The t-test was used to compare the vermillion height ratio between the two groups. The mean age at surgery was 4±1.3months in the STSF group and 4.3±0.6years in the NSTSF group. There was no significant difference in vermillion height ratio at 5 years of age between the patients in the two groups. Thus, there is no difference in vermillion height ratio with or without a STSF in cleft lip repair. The use of a small triangular skin flap needs to be assessed carefully, as it will create an unsightly scar over the philtrum area.

Matched MeSH terms: Skin Transplantation
Fulltext Chitosan dermal substitute and chitosan skin substitute contribute to accelerated full-thickness wound healing in irradiated rats

Mohd Hilmi AB, Halim AS, Jaafar H, Asiah AB, Hassan A

Biomed Res Int, 2013;2013:795458.
PMID: 24324974 DOI: 10.1155/2013/795458

Wounds with full-thickness skin loss are commonly managed by skin grafting. In the absence of a graft, reepithelialization is imperfect and leads to increased scar formation. Biomaterials can alter wound healing so that it produces more regenerative tissue and fewer scars. This current study use the new chitosan based biomaterial in full-thickness wound with impaired healing on rat model. Wounds were evaluated after being treated with a chitosan dermal substitute, a chitosan skin substitute, or duoderm CGF. Wounds treated with the chitosan skin substitute showed the most re-epithelialization (33.2 ± 2.8%), longest epithelial tongue (1.62 ± 0.13 mm), and shortest migratory tongue distance (7.11 ± 0.25 mm). The scar size of wounds treated with the chitosan dermal substitute (0.13 ± 0.02 cm) and chitosan skin substitute (0.16 ± 0.05 cm) were significantly decreased (P < 0.05) compared with duoderm (0.45 ± 0.11 cm). Human leukocyte antigen (HLA) expression on days 7, 14, and 21 revealed the presence of human hair follicle stem cells and fibroblasts that were incorporated into and surviving in the irradiated wound. We have proven that a chitosan dermal substitute and chitosan skin substitute are suitable for wound healing in full-thickness wounds that are impaired due to radiation.

Matched MeSH terms: Skin Transplantation*
Correlation of donor age and telomerase activity with in vitro cell growth and replicative potential for dermal fibroblasts and keratinocytes

Ng MH, Aminuddin BS, Hamizah S, Lynette C, Mazlyzam AL, Ruszymah BH

J Tissue Viability, 2009 Nov;18(4):109-16.
PMID: 19632116 DOI: 10.1016/j.jtv.2009.06.003

Previous studies suggested telomerase activity as a determinant of cell replicative capacity by delaying cell senescence. This study aimed to evaluate the feasibility of adopting telomerase activity as a selection criterion for in vitro expanded skin cells before autologous transplantation. Fibroblasts and keratinoctyes were derived from the same consenting patients aged 9-69 years, and cultured separately in serum-supplemented and serum-free media, respectively. Telomerase activity of fresh and cultured cells were measured and correlated with cell growth rate, donor age and passage number. The results showed that telomerase activity and cell growth were independent of donor age for both cell types. Telomerase was expressed in freshly digested epidermis and dermis and continued expressing in vitro. Keratinocytes consistently showed 3-12 folds greater telomerase activity than fibroblast both in vivo and in vitro. Conversely, growth rate for fibroblast exceeded that of keratinocyte. Telomerase activity decreased markedly at Passage 6 for keratinocytes and ceased by Passage 3 for fibroblasts. The decrease or cessation of telomerase activity coincided with senescence for keratinocyte but not for fibroblast, implying a telomerase-regulated cell senescence for the former and hence a predictor of replicative capacity for this cell type. Relative telomerase activity for fibroblasts from the younger age group was significantly higher than that from the older age group; 69.7% higher for fresh isolates and 31.1% higher at P0 (p<0.05). No detectable telomerase activity was to be found at later subcultures for both age groups. Similarly for keratinocytes, telomerase activity in the younger age group was significantly higher (p<0.05) compared to that in the older age group; 507.7% at P0, 36.8% at P3 and the difference was no longer significant at P6. In conclusion, the study provided evidence that telomerase sustained the proliferation of keratinocytes but not fibroblasts. Telomerase activity is an important criterion for continued survival and replication of keratinocytes, hence its positive detection before transplantation is desirable. Inferring from our results, the use of keratinocytes from Passage 3 or lesser for construction of skin substitute or cell-based therapy is recommended owing to their sustained telomerase expression.

Matched MeSH terms: Skin Transplantation*
Quality evaluation analysis of bioengineered human skin

Mazlyzam AL, Aminuddin BS, Lokman BS, Isa MR, Fuzina H, Fauziah O, et al.

Med J Malaysia, 2004 May;59 Suppl B:39-40.
PMID: 15468808

Our objective is to determine the quality of tissue engineered human skin via immunostaining, RT-PCR and electron microscopy (SEM and TEM). Culture-expanded human keratinocytes and fibroblasts were used to construct bilayer tissue-engineered skin. The in vitro skin construct was cultured for 5 days and implanted on the dorsum of athymic mice for 30 days. Immunostaining of the in vivo skin construct appeared positive for monoclonal mouse anti-human cytokeratin, anti-human involucrin and anti-human collagen type I. RT-PCR analysis revealed loss of the expression for keratin type 1, 10 and 5 and re-expression of keratin type 14, the marker for basal keratinocytes cells in normal skin. SEM showed fibroblasts proliferating in the 5 days in vitro skin. TEM of the in vivo skin construct showed an active fibrocyte cell secreting dense collagen fibrils. We have successfully constructed bilayer tissue engineered human skin that has similar features to normal human skin.

Matched MeSH terms: Skin Transplantation/standards*
Laminated pedicled latissimus dorsi myocutaneous flap for single-stage reconstruction of a composite anterior neck and tracheal defect

Wu LY, Halim AS, Sain AH

J Otolaryngol, 2005 Feb;34(1):69-72.
PMID: 15966482
Matched MeSH terms: Skin Transplantation/methods*
Fulltext Histological and mechanical evaluation of antifreeze peptide (Afp1m) cryopreserved skin grafts post transplantation in a rat model

Ibrahim SM, Kareem OH, Saffanah KM, Adamu AA, Khan MS, Rahman MBA, et al.

Cryobiology, 2018 06;82:27-36.
PMID: 29679551 DOI: 10.1016/j.cryobiol.2018.04.012

The objective of this study was to evaluate the use of Afp1m as a cryopreservative agent for skin by examining the transplanted skin histological architecture and mechanical properties following subzero cryopreservation. Thirty four (34) rats with an average weight of 208 ± 31 g (mean ± SD), were used. Twenty four (n = 24) rats were equally divided into four groups: (i) immediate non-cryopreserved skin autografts (onto same site), (ii) immediate non-cryopreserved skin autografts (onto different sites), (iii) skin autografts cryopreserved with glycerol for 72 h and (iv) skin autografts cryopreserved with Afp1m for 72 h at -4 °C. Rounded shaped full-thickness 1.5-2.5 cm in diameter skin was excised from backs of rats for the autograft transplantation. Non-cryopreserved or cryopreserved auto skin graft were positioned onto the wound defects and stitched. Non-transplanted cryopreserved and non-cryopreserved skin strips from other ten rats (n = 10) were allowed for comparative biomechanical test. All skin grafts were subjected to histological and mechanical examinations at the end of day 21. Histological results revealed that tissue architecture especially the epidermal integrity and dermal-epidermal junction of the Afp1m cryopreserved skin grafts exhibited better histological appearance, good preservation of tissue architecture and structural integrity than glycerolized skin. However, there was no significant difference among these groups in other histological criteria. There were no significant differences among the 4 groups in skin graft mechanical properties namely maximum load. In conclusion, Afp1m were found to be able to preserve the microstructure as well as the viability and function of the skin destined for skin transplantation when was kept at -4 °C for 72 h.

Matched MeSH terms: Skin Transplantation*
Fulltext Skin paddle as an indicator of the viability of vascularised fibular graft

Imran Y, Zulmi W, Halim AS

Singapore Med J, 2004 Mar;45(3):110-2.
PMID: 15029411

Immediate recognition of anastomotic failure is important to ensure the viability of the vascularised fibular graft. The problems associated with post-operative bone scanning and angiography for immediate detection of anastomotic failure have been described.

Matched MeSH terms: Skin Transplantation*

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