Attaluri Pradeep K, Shaffrey Ellen C, Wirth Peter J, Gaio Natalie, Bentz Michael L
Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Department of Orthopedic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
J Pediatr Soc North Am. 2024 Feb 12;5(3):744. doi: 10.55275/JPOSNA-2023-744. eCollection 2023 Aug.
Congenital orthopaedic anomalies and acquired pediatric wounds of the extremities frequently require reconstruction of the soft tissue envelope. In many of these circumstances, full-thickness skin grafting (FTSG) is a reliable and appropriate reconstructive option. However, FTSG harvest is rarely discussed in the orthopaedic literature. We present a reliable and reproducible method of full-thickness skin grafting that is easily performed. In this technique, we harvest a full-thickness skin graft from the lower abdomen using a symmetric transverse midline suprapubic incision (i.e., Pfannenstiel incision). This donor site allows for abundant skin graft harvest while providing a concealed location and the potential for additional graft harvest. Finally, we discuss the critical importance of postoperative recipient site dressings to optimize skin graft take.
•Full-thickness skin grafts (FTSG) represent a straightforward and reliable strategy for pediatric orthopaedic reconstruction in the appropriate patient.•Skin grafts rely on a healthy recipient wound bed to heal in three distinct phases-plasmatic imbibition, inosculation, and revascularization.•FTSG result in less secondary long-term contracture than split-thickness skin grafts (STSG), which is crucial for the growing extremity and why they are preferred for use over joints and areas of motion.•FTSG can be harvested from a symmetrically designed low transverse suprapubic midline incision to facilitate primary and repeat skin graft harvest and minimize ambiguity regarding prior abdominal surgery.•The most common causes of skin graft failure include shear forces, fluid collections, and infection, making the recipient site surgical dressing of paramount importance.
先天性骨科畸形和儿童后天性肢体伤口常常需要对软组织包膜进行重建。在许多这类情况下，全厚皮片移植（FTSG）是一种可靠且合适的重建选择。然而，骨科文献中很少讨论FTSG的取材。我们介绍一种易于操作的可靠且可重复的全厚皮片移植方法。在这项技术中，我们通过耻骨上横正中对称切口（即Pfannenstiel切口）从下腹部获取全厚皮片。该供区能获取大量皮片，同时位置隐蔽，还有再次获取皮片的可能。最后，我们讨论术后受区敷料对优化皮片存活的关键重要性。
•全厚皮片（FTSG）对于合适的患儿是小儿骨科重建的一种直接且可靠的策略。
•皮片依靠健康的受区创面床在三个不同阶段愈合——血浆吸收、吻合和再血管化。
•与中厚皮片（STSG）相比，FTSG导致的二期长期挛缩更少，这对于生长中的肢体至关重要，也是在关节和活动部位优先使用FTSG的原因。
•FTSG可从对称设计的低位耻骨上横正中切口获取，以利于初次和再次皮片取材，并使既往腹部手术的不确定性最小化。
•皮片失败的最常见原因包括剪切力、积液和感染，这使得受区手术敷料至关重要。
