Split-thickness skin graft donor-site morbidity: A systematic literature review

Breast cancer is one of the leading malignancies in women.1 Despite advances in chemotherapy, hormone therapy, and radiotherapy, curative treatment for breast cancer requires surgical intervention, often in the form of a mastectomy.2,3 As the loss of breasts has deleterious effects both on patients’ psyche and their long-term outcomes, breast reconstruction has become standard of care post mastectomy.4–6 There are numerous options for breast reconstruction including the timing (immediate versus delayed), extent of resection (nipple/skin sparing, simple, and modified radical), and mass of reconstructed breast mound (autologous—TRAM, DIEP, GAP LDM flap, and prosthetics—tissue expander/implant). Given the innumerable combinations of these options, several studies have attempted to compare different methods. Currently, there is evidence that an immediate reconstruction may be superior to delayed reconstruction.2 Furthermore, there is evidence that nipple- and skin-sparing mastectomies are sufficient as a curative treatment and superior for cosmesis.7 Therefore, in the context of a growing trend of immediate reconstruction after nipple- and skin-sparing mastectomies, it is not surprising that the use of tissue expander–based and implant-based reconstruction accounts for over 80% of the 102,215 breast reconstructions reported by the American Society of Plastic Surgeons for 2014.8 For these tissue expander–based and implant-based reconstructions, there is another growing trend—the use of an acellular dermal matrix (ADM) as an integral component of the surgery.9–11

The ADM was introduced in the mid-1990s for burn reconstruction, but its use has expanded to include many applications.12 In particular, in the mid-2000s, several reports were published showing the benefits of using ADM in implant-based and tissue expander–based reconstruction.13–18 Since that time, the use of ADM in these procedures has grown tremendously. Several advantages of using an ADM have been reported. These include claims of superior benefits in terms of cosmetic outcomes secondary to greater control of the inframammary fold position (ie, more support, less visible implant rippling, and more fullness of lower pole), lower incidence of capsular contracture, higher initial volumes of implants and tissue expanders with shorter time to full expansion, and less tension on mastectomy skin flaps.19–22 However, only some of these benefits have been formally evaluated.23

Given the increased use of ADMs, several companies have introduced their own versions of ADM that vary in a number of properties including harvesting source, cross-linking management, and the process for removing antigens. With the advent of these newer ADMs, there is a need to compare these different matrices in terms of complication frequency and type. Here, we add to this growing and necessary literature by comparing 2 human ADMs: the AlloDerm regenerative tissue matrix (RTM, LifeCell Corporation, Bridgewater, N.J.) and Cortiva allograft dermis (RTI Surgical, Alachua, Fla.). Although the characteristics of the AlloDerm RTM are documented elsewhere,24 Cortiva is an 8- x 16-cm Tutoplast-sterilized, noncrosslinked allograft dermis (Fig. ​(Fig.11).



Fig. 1.

Cortiva ADM integration. Image of the Cortiva ADM integration in a patient undergoing tissue expander to implant exchange.

A Complication Analysis of 2 Acellular Dermal Matrices in Prosthetic-based Breast Reconstruction.

https://repub.eur.nl/pub/133198/Repub_133198_O-A.pdf

Patient-reported scar quality of donor-sites following split-skin grafting in burn patients: Long-term results of a prospective cohort study.

Reducing implant loss rates in immediate breast reconstructions

Abdominoplasty procedures have been proven highly valuable in promoting better quality of life for post-bariatric surgery patients. The literature reveals that the aspect of the navel is one of the most problematic issues regarding surgical results and many different surgical techniques have been proposed to obtain a satisfactory outcome. However, little is known about patients’ preferences regarding these different techniques and their results. The aim of the present study was to compare evaluations made by plastic surgeons and patients of the results of two different techniques—traditional omphaloplasty and neo-omphaloplasty with lateral flaps. Five plastic surgeons analyzed postoperative pictures of 54 post-bariatric abdominoplasties performed between 2008 and 2013 at the Unicamp Hospital. Pictures of 12 cases were selected and evaluated by 50 patients waiting for a post-bariatric abdominoplasty. A standardized scale was used that contained the following criteria: volume of the abdomen, lateral contour, quality of the scars, umbilicus and skin excess/flaccidity. Surgeons gave the highest scores to 71.6% of neo-omphaloplasty cases and patients to 43.7%. Both surgeons and patients graded navels operated on using this technique higher, although the comparison was not statistically significant for patient evaluations (p = 0.062). The navel aspect was considered the fourth most relevant aspect among those evaluated. Neo-omphaloplasty results were considered better than traditional omphaloplasty for surgeons and patients, although there was not a clear differentiation of results by the latter. The navel postoperative aspect was considered secondarily important by patients to the results of post-bariatric abdominoplasties. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266
 .

Patient Versus Surgeon Preferences Between Traditional and Neo-omphaloplasty in Post-bariatric Abdominoplasty.

Autologous split-thickness skin grafting has been proven to provide the best cosmetic and functional outcome after cutaneous burn injuries and thus is the standard of care. Clinical observations have shown that female burn patients frequently have greater difficulty choosing a donor site than do male burn patients. However, there is a lack of data characterizing donor-site preferences among women with burns.
The purpose of this study was to examine donor-site preferences among women using an online survey that included 356 responders between January 4, 2012, and April 4, 2012.
This study found that there was a preference for posterior donor sites, with lower back, left buttock, and left posterior thigh being the most preferred sites. The least preferred locations were the right anterior upper arm, any aspect of the forearms, and the chest. Those surveyed and reporting a higher education level or concerns with scarring were least likely to choose anterior locations. Age, concern for color changes, and prior surgery or grafting had no statistically significant effect on donor-site preference.
Given these strong preferences among female patients, posterior donor sites should be considered and discussed as compared with the current standard of using lateral or anterior thigh donor sites.

Donor-site preferences in women during autologous skin grafting.

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Donor-site preferences in women during autologous skin grafting.