Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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New proposal for skin grafts on tendon-exposed wounds

  • Um, Jung Hwan (Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine) ;
  • Jo, Dong In (Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine) ;
  • Kim, Soon Heum (Department of Plastic and Reconstructive Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine)
  • Received : 2021.02.07
  • Accepted : 2021.09.29
  • Published : 2022.01.15
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Abstract

Performing a skin graft is not feasible for tendon-exposed defect reconstruction because tendons are fibrous connective tissues with relatively poor blood supply. This study proposes a method to effectively perform skin graft surgery in tendon-exposed wounds. A 48-year-old male patient with diabetes mellitus had a very large left dorsal foot defect (8×8 cm). The wound bed had healthy granular tissue, with tendon exposure. The tendons were turned over so that the posterior side would behave as the anterior side. The edge of the paratenon was then fixed together to the surrounding granulation tissue or dense remnant fascia using absorbable sutures, and the close granulation tissue was approximated and buried. A split-thickness skin graft was performed after 1 week. The graft site was stably taken on postoperative day 3. A small disruption was then observed at the graft site within 1 week postoperatively, but conservative treatment was continued for 1 month, after which the defect site was completely restored. This technique can increase the success rate of skin grafts for defects with tendon exposure.

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References

  1. Aerden D, Bosmans I, Vanmierlo B, et al. Skin grafting the contaminated wound bed: reassessing the role of the preoperative swab. J Wound Care 2013;22:85-9. https://doi.org/10.12968/jowc.2013.22.2.85
  2. Park JW. Reconstruction of a traumatic soft tissue defect. J Korean Fract Soc 2015;28:256-65. https://doi.org/10.12671/jkfs.2015.28.4.256
  3. Takasugi H, Akahori O, Nishihara K, et al. Three-dimensional architecture of blood vessels of tendons demonstrated by corrosion casts. Hand 1978;10:9-15. https://doi.org/10.1016/S0072-968X(78)80020-5
  4. Schmidt-Rohlfing B, Graf J, Schneider U, et al. The blood supply of the Achilles tendon. Int Orthop 1992;16:29-31. https://doi.org/10.1007/BF00182980
  5. Ahmed IM, Lagopoulos M, McConnell P, et al. Blood supply of the Achilles tendon. J Orthop Res 1998;16:591-6. https://doi.org/10.1002/jor.1100160511
  6. Lese I, Biedermann R, Constantinescu M, et al. Predicting risk factors that lead to free flap failure and vascular compromise: a single unit experience with 565 free tissue transfers. J Plast Reconstr Aesthet Surg 2021;74:512-22. https://doi.org/10.1016/j.bjps.2020.08.126
  7. Scherer S, Pietramaggiori G, Orgill DP. Skin graft. In: Neligan PC, editor. Plastic surgery. 3rd ed. New York: Elsevier; 2012. p. 323-4.
  8. Blume PA. Skin grafts. In: Dockery GD, Crawford ME. Low extremity soft tissue & cutaneous plastic surgery. Edinburgh: Elsevier; 2012. p. 207.
  9. Kim JB, Han SK, Kim WK. Deepithelialized split thickness skin graft. J Korean Wound Care Soc 2006:2:34-40.
  10. Chansky HA, Iannotti JP. The vascularity of the rotator cuff. Clin Sports Med 1991;10:807-22. https://doi.org/10.1016/s0278-5919(20)30585-8
  11. Brockis JG. The blood supply of the flexor and extensor tendons of the fingers in man. J Bone Joint Surg Br 1953;35-B:131-8. https://doi.org/10.1302/0301-620X.35B1.131
  12. Gelberman RH. Flexor tendon physiology: tendon nutrition and cellular activity in injury and repair. Instr Course Lect 1985;34:351-60.