BACKGROUND: Patients with melanoma have been found to be at greater risk of adverse outcomes including mortality after contacting COVID-19. Management of postsurgical complications presented additional challenges by potentially increasing exposure to COVID-19 through repeated inpatient admissions to hospital during the pandemic. We report four cases for which skin flaps, lymph ligation, and split-thickness skin graft (STSG) were successfully used in the treatment of complications in the trunk and extremities after wide local excision (WLE). This study details the operative experience in management of postsurgical complications for melanoma in the trunk and extremities during a 6-month period at the height of the COVID-19 pandemic.
METHODS: We present 4 cases detailing management of complications that occurred after wide local excisions performed for melanoma during Feb. to Oct. 2020. Case 1: A 90-year-old man who experienced wound dehiscence and necrosis on the shoulder after non-radical excision for an aggressive melanoma and underwent the side-to-side closure after ellipse formed WLE with modified tangent-to-circle method. Case 2: An 80-year-old man who had undergone excision for melanoma in his left upper arm and histopathology did not show radically. Two weeks after the excision, he underwent a WLE and direct reconstruction with double rotation skin flap. Case 3: A 55-year-old man that experienced a large wound dehiscence on his back due to WLE. He underwent an advanced double skin flap operation. Case 4: A 36-year-old woman who had a lymphorrhea and graft necrosis after WLE and STSG on the right lower leg. A combination of micro lymph ligation and re-STSG was performed. One month after the operation, all wounds had healed. There was no clinical evidence of tumor recurrence after 8 months post procedure.
CONCLUSIONS: Severe complications (e.g., large wound dehiscence, necrosis, or lymphorrhea) following wide local excision of melanoma are infrequent but must be swiftly and appropriately managed, especially during the COVID-19 pandemic to decrease the likelihood of COVID-19 infection and impaired oncology outcomes from delaying systemic cancer therapy due to the complications in primary interventions.

UNASSIGNED: NovoSorb (Poly-Novo Ltd, Australia) biodegradable temporising matrix (BTM) is a novel artificial dermal matrix. Previous literature is weighted towards its use in burns reconstruction; however, this paper describes its use within a range of wound aetiologies. The authors present one of the largest and most diverse case series to date, and aim to provide an independent benchmark of clinical practice.
UNASSIGNED: A retrospective observational study was performed. Patient demographics and clinical data (wound aetiology, site, total body surface area (TBSA), wound bed, number of debridements, time to BTM integration, time to skin grafting) were collected and subgroup analysis preformed.
UNASSIGNED: The cohort consisted of 37 patients (acute trauma wounds, n=19; hard-to-heal wounds, n=9; acute infections, n=6; cancer, n=3). Successful BTM integration, allowing subsequent split-thickness skin grafting (STSG), occurred in 70% of cases, despite an overall complication rate of 51%. Mean time from BTM application to STSG was 53 days. There was no difference in STSG outcomes when grafting was performed either before or after the six-week BTM application period. There was no difference when various wound beds (fascia, tendon, periosteum) were compared. Patients >65 years of age were more likely to experience complications; however, this did not affect the speed of integration. The relation of diabetes and smoking to overall integration had no statistical significance.
UNASSIGNED: In comorbid patients in particular, the time between BTM application and STSG may be longer than the manufacturer\'s recommendation. Furthermore, data suggest greater wound bed optimisation and closer interval monitoring in hard-to-heal/malignant wounds, and in older patients and patients with comorbidities. However, BTM appears robust (even in infection) and is showing promise as a useful reconstructive tool.

Reconstruction of a scalp defect should ensure the skull\'s protection, soft-tissue bulk, and contour maintenance. When calvaria is exposed, each reconstruction option has its own advantages and disadvantages. We report a 2-year-old Saudi boy, a road traffic accident (RTA) victim, otherwise medically stable who sustained partial to full-thickness defects of the scalp involving the left temporoparietal region, measuring 20 × 10 cm2 in size. After optimal debridement of the wound, a bipedicled pericranial flap with a split-thickness skin graft (STSG) was done. This case reports the satisfactory outcomes of using a bipedicled pericranial flap with STSG in traumatic scalp injuries, specifically in the pediatric age population without creating any secondary scalp skin defect and its associated morbidities. Being bipedicled the vascularity of the flap is more reliable and robust.

BACKGROUND: We present a case of a rare complication of negative-pressure wound therapy (NPWT) wherein there was fixation of a meshed split-thickness skin graft (STSG), suspected as a failure by hypergranulation. However, the meshed STSG was integrated within 5 days of NPWT cessation.
METHODS: A 22-year-old Asian man sustained 25% total-body-surface-area flame burns. After multiple operations, an ulcer was present on the proximal left thigh. On day 37 after admission, the ulcer was debrided, and an 11/1000-inch (0.28 mm) skin graft was taken from the ipsilateral thigh and meshed, using a 1:1.5 ratio. NPWT was applied to the donor and recipient sites with a continuous negative pressure of 125 mmHg. On day 43, NPWT was discontinued. The skin grafts were not identified on the surface of the granulation tissue. With topical ointment therapy, rapid epithelialization of the ulcer was observed as the granulation tissue regressed. On day 48, the recipient site had completely epithelialized.
CONCLUSIONS: The hypergranulation tissue rarely covered the meshed STSGs when the grafts were fixed by NPWT. In that case, immediate debridement should be avoided, and conservative treatment should be initiated.

Soft tissue ulceration resulting from chronic venous insufficiency is a common condition that requires standardised long-term therapy, which has been thoroughly established. We report a patient with a five-year history of persistent venous stasis ulcers despite treatment consistent with traditional wound care. Resolution of the ulcers began only upon deviation from conventional therapy. This report considers non-standard treatments in patients with venous ulcers that do not progress.

Split-thickness skin graft (STSG) helps to promote healing of wounds by providing a viable soft tissue cover. However, the success of which is influenced by how well it takes to the recipient site. Studies have demonstrated that negative pressure wound therapy (NPWT) is an excellent modality to promote graft survival. Technological advancements have made possible the invention of disposable, ultraportable, and mechanically operated versions for improved user experience. Alas, little has been discussed about their benefits on STSG. Therefore, the purpose of this case report is to highlight the effective use of disposable NPWT on freshly applied STSG. We report here a novel use of the disposable NPWT (SNAP therapy system) for STSG recipient sites in two patients with peripheral arterial disease (PAD) foot wounds. In both patients, there was 100% STSG uptake, and the lightweight disposable NPWT system makes for a more cost-effective and comfortable experience for patients. Disposable NPWT may be a feasible alternative to conventional NPWT to aid with STSG uptake for PAD foot wound recipient sites.

BACKGROUND: Although skin avulsions to male external genitalia are rare, they can be both physically and psychologically traumatic. Thus, the necessity for judicious management poses significant challenges to surgeons in order to avoid potential permanent disabilities. We report a case of massive penoscrotal skin avulsion and a composite graft was creatively applied to cover the defect which achieved good results. We believe that this case is of great reference value for fellow surgeons.
METHODS: A 52-year-old male presented with massive traumatic avulsion of the penile and scrotal skin following mishandling of an electric drill. The avulsed skin was missing. The patient was diagnosed with massive skin avulsion of external genitalia. Following initial complete debridement of devitalized or infected tissues, Pelnac dermal substitute was secured to the defect with the assistance of negative-pressure wound closure. In the final step, the silicone layer of Pelnac was removed and a split-thickness skin graft was applied. The defect had healed at the two-month follow-up. The patient now has normal erections and satisfactory sexual function.
CONCLUSIONS: Our experience with this wound repair demonstrated that the combination of a dermal regeneration template and a split-thickness skin graft with vacuum-assisted closure is a safe, well-tolerated and efficient solution for the reconstruction of massive penoscrotal skin defects.

BACKGROUND: Penile denudation is a devastating condition often reconstructed with a split-thickness skin graft(STSG). As this kind of reconstruction is challenging, we present an non-invasive treatment using Manuka honey dressings with a satisfying result. This was performed as a salvage procedure after failed STSG.
METHODS: A 55-year-old non-smoking male was admitted from his general practitioner with a newly onset of phimosis and lower urinary tract symptoms. Benign tumours complicated with infection were found on all segments of the penis causing dehiscence of the skin. After surgical removal of tumours and an unsuccessful STSG, Manuka honey dressings was used. Full sexual function was regained, and the patient was satisfied with the result.
CONCLUSIONS: Alternatives to STSG are full-thickness skin graft using the inguinal or scrotal borrowing method, or using a dermal matrix before a STSG. A rediscovered method is using Manuka honey, with its unique combination of bactericidal, anti-inflammatory and healing-promoting properties. A wide range of wound types may benefit from Manuka honey dressings. A recent Danish in vitro study on honey derived from various Danish floras even shows high antibacterial effect superior to commercial medical grade honey. Considering a growing resistance to antibiotics, medical honey may contribute as a alternative to extensive wound care.
CONCLUSIONS: We successfully treated a penile denudation with Manuka honey following a failed STSG. Wounds, ulcers, and burns may be infected, and can be challenging, time consuming, and expensive to treat. Manuka honey may be a good alternative to reconstructive surgery and can be managed on an out-patient basis.

BACKGROUND: Male genital degloving injuries are unusual and rarely caused by animal bite. Usually patients attend health care immediately if bitten in the genital area. Prophylactic antibiotics is routinely used (Gomes et al., 2000). A penile degloving usually begins just proximal of the coronal line and progress down to the base of the shaft. Deep erectile tissue and the spermatic cord are seldom damaged and the endogenous skin of glans usually survives (Brown and Fryer, 1957; Morey et al., 2004; Finical and Arnold, 1999).
METHODS: A heavily smoking man with a previous history of bladder cancer presented himself to the emergency department 24h after a dog bite degloved his penis. The avulsed skin was necrotic and subsequently excised. Antibiotic treatment was started. A bacterial swab was found positive for canine oral flora. The skin defect was closed using a 1:1 meshed split thickness skin graft from the inner thigh. Smoking cessation was encouraged. At the three month follow up the patient expressed satisfaction with both cosmetic and functional result and was now non-smoking.
CONCLUSIONS: Several approaches to reconstruct penile skin exist. Split thickness skin graft has been lifted as a preferable alternative (Brown and Fryer, 1957; Finical and Arnold, 1999; Paraskevas et al., 2003) [5]. In this case, the avulsed skin was necrotic and could not be used. A 1:1 meshed split-thickness graft was chosen with excellent results.
CONCLUSIONS: 1:1mesh of the graft can be recommended for easy attachment with a good functional and esthetical result. The potential risk of losing intimacy appearance or having to go through repeated procedures in the genital area motivated smoking cessation for this patient.

Skin cancers requiring nasal resection may be surgically reconstructed and/or prosthetically reconstructed. Singular surgical reconstruction may be ideal for smaller defects in which the nasal bone and cartilaginous portions of the nose are maintained, but surgical reconstruction falls short of providing acceptable aesthetic results for more extensive nasal defects. Prosthetic rehabilitation, or a combination of surgical and prosthetic rehabilitation, is more appropriate for larger defects, but prosthesis retention can be challenging when adhesives are required on adjacent mobile and secreting skin.
We report 2 cases of patients with extensive nasal defects who were successfully rehabilitated with nasal prostheses. The nasal defects were surgically optimized with immediate preparation of the surgical margins, placement of a split-thickness skin graft (STSG) within the nasal cavities and exposed maxillary sinuses, and immediate placement of osseointegrated implants.
Excellent prosthetic retention can be achieved without the need for adhesives. A skin graft-lined defect has minimal secretions and allows for improved defect cleansing.
The success of a nasal prosthesis depends on appropriate surgical management of the defect, and, thus, collaboration between the various surgical and prosthetic teams is essential. © 2016 Wiley Periodicals, Inc. Head Neck 39: E4-E11, 2017.