Background: One of the cosmetic problems after a skin graft operation is the scar caused by sutures. This report describes a method of graft fixation without sutures that allows for an improved aesthetic appearance. Methods: Mepitel® One (Mölnlycke®, Tokyo, Japan) multiparous silicon sheet is a self-adhesive transparent sheet was cut out slightly wider than the area of the skin defect and applied to the area for skin harvesting. The graft with Mepitel® One was harvested and transplanted to the defect and this graft was secured with another Mepitel® One. After one to two weeks, all Mepitel® One was removed, and an ointment containing antibiotics was applied. Results: Twenty-three patients (8 men and 15 women) underwent this procedure. The maximum size of the skin graft fragments was 55 mm × 70 mm. In three cases, infection led to partial necrosis, but resulted in epithelialization without scarring contracture. The other cases healed completely. Conclusions: This method has many advantages: (1) Using Mepitel® One as a template for skin retrieval, Mepitel® One will not tear even if it is contaminated with water or blood. (2) In Mepitel® One, it is easy to distinguish the polyurethane film side from the adhesive side, so there is no chance of mistaking the front and back when using it as a template. (3) Because Mepitel® One remains attached to the skin even after harvesting, it prevents the graft from curling up and eliminates the need to redeploy the graft at the wound bed. This makes it possible to transplant without suturing the skin graft, eliminates the need for local anesthetic injections, and shortens the operation time.
Background: Currently, there is no standardized treatment protocol on the use of sodium thiosulfate for calciphylaxis. This study may be the first to evaluate the efficacy and safety of treatment with sodium thiosulfate in Japanese patients. Methods: To avoid side effects, we started intravenous sodium thiosulfate at a low daily dosage (10 g/day) and gradually increased it. In case 1 (a non-dialysis patient), the initial dose was 10 g/day. In cases 2 and 3 (both dialysis patients), intravenous sodium thiosulfate was started at a dose of 10 g after each dialysis, which was gradually increased. In cases 1 and 3, intralesional sodium thiosulfate was incorporated. Results: After initiating treatment with sodium thiosulfate, a decrease in ulcer area was observed in all three patients. On the other hand, patients experienced nausea, metabolic acidosis, and disturbance of consciousness. The decrease in pH after the initiation of sodium thiosulfate treatment was statistically significant (mean decrease=-0.011, P<0.05). In addition, pH values tended to show an inverse correlation with the daily dosage during intravenous sodium thiosulfate treatment. Disturbance of consciousness was observed in two out of three patients at the same time as acidosis. However, the cause was thought to be sepsis and/or discontinuation of dialysis. Conclusions: Sodium thiosulfate can be effective in Japanese patients, even with a lower daily dosage than that used in other countries. Careful monitoring of potential side effects is needed.
A bilaminated dermal regeneration substitute usually requires a two-step procedure to achieve wound closure. Integra thin® (Integra Life sciences Crop., NJ, USA) is thinner than bilayer Integra® and does not require additional waiting time for the formation of the neodermis, making it possible to undertake the reconstruction of full-thickness skin defects in a single-stage procedure. We describe the successful use of Integra thin® in a single-stage procedure in combination with a split-thickness skin graft in a patient who was diagnosed with cutaneous malignancy after surgery.
Introduction: Incisional negative pressure wound therapy (iNPWT) is a preventive measure for postoperative wound dehiscence in which negative pressure is applied to the suture wound. Indeed, insufficient drainage in the deep layer is associated with an increased risk of developing subcutaneous hematoma and wound complications. Here, we report two cases of lower limb degloving injury successfully managed by iNPWT, with the reinforcement of subcutaneous drainage (hybrid-iNPWT). Case presentation: Case 1 was that of an 87-year-old man who sustained a deep, dissecting hematoma of the left lower leg associated with the sensation of severe tightness and pain. After emergency incision and removal of the hematoma in the deep fascia, we performed a primary closure of the flap wound. A negative pressure of 80 mmHg was applied to the sutured wound via foam dressing (iNPWT). Concurrently, we connected the negative pressure device with a subcutaneous drainage tube inserted under the flap (hybrid-iNPWT). The flap survived without recurrence of hematoma. Case 2 was that of an 89-year-old woman with a right lower leg degloving injury. The skin and subcutaneous tissues were detached from the underlying fascia. After primary closure of the flap, hybrid-iNPWT was performed at a subatmospheric pressure of 80 mmHg. The patient was discharged without any complications related to wound healing. Discussion: The aim of using hybrid-iNPWT was to apply negative pressure not only to the surface of the sutured wound but also to the posterior portion of the flap. The intensity of the negative pressure provided by the iNPWT device was higher than that of the conventional suction drainage tube system. Hybrid-iNPWT can be an alternative solution for hematoma prevention and may allow early ambulation in the management of lower limb degloving injuries in elderly patients.
Arteriovenous fistulas in the lower limbs are usually caused by trauma or surgical intervention and may sometimes be congenital. Furthermore, the occurrence of multiple spontaneous arteriovenous fistulas with peripheral artery disease is rare. Herein we describe a rare case of critical limb ischemia, generally caused by arteriosclerosis, with multiple spontaneous arteriovenous fistulas and peripheral artery disease. An 83-year-old woman with a history of diabetes mellitus, hypertension, and diabetic nephropathy visited our hospital. An ulcer haddeveloped on her left first toe after surgery of an ingrown nail. She was diagnosed with critical limb ischemia due to decreased skin perfusion pressure in her lower leg. Angiography revealed multiple arteriovenous fistulas and severe peripheral artery disease. Below-knee amputation was initially ruled out because of lower leg ischemia. Thus, we first attempted partial ligation of the arteriovenous fistulas of the popliteal region to improve blood flow in the lower leg. Subsequently, we performed below-knee amputation without any complications. In conclusion, we were able to improve blood flow in the lower leg with partial arteriovenous fistula ligation surgery and preserved the knee joint.
The scalp is a common donor site used to cover extensive burn wounds or for degloving skin injuries in children. After split-thickness skin grafts (STSGs) are harvested from the scalp, the short hair fragments are removed to reduce infection and failure rates. Using surgical tape strips is an ideal method to remove hair fragments from the STSGs. These strips have several advantages. They remove the hair fragments easily from the grafts and are relatively gentle on the sensitive skin of children. Additionally, they are cost-effective and generally used intra-operatively.