We review a case of total penile skin replacement with split-thickness micromesh skin graft (micromesh STSG) due to paraffinoma.

Fournier gangrene (FG) is a life-threatening necrotizing soft-tissue infection of the perineum and external genitalia, which primarily occurs in obese, diabetic males. The mainstay of treatment is source control via early aggressive surgical excision. Wide surgical excision can result in significant soft tissue defects that can be disfiguring and difficult to close. The most common method of closure is split-thickness skin grafting (STSG). Recently, autologous skin cell suspension (ASCS) technology has been used in addition to STSG to provide better wound healing and closure. This patient experienced excellent wound progression, following FG, through the application of ASCS with STSG, despite challenges related to the wounds, anatomical location, comorbidities, size, and the patient\'s medical history.

Aplasia cutis congenita (ACC) is a rare congenital disease defined by the absence of skin, most commonly on the scalp. While the exact incidence remains uncertain, ACC presents a significant challenge in clinical management due to its variable presentation and associated complications. We present the case of a newborn male with a large scalp defect attributed to ACC, complicated by a life-threatening scalp hemorrhage. Despite challenges in management, including recurrent infections and failed skin grafts, the patient ultimately achieved satisfactory healing following a series of surgical interventions, including local transposition flap procedures. This case underscores the importance of a multidisciplinary approach to managing ACC, tailored to individual patient characteristics and associated risks. While discrete lesions of ACC typically have a favorable prognosis, extensive defects pose significant risks of morbidity and mortality, highlighting the need for careful consideration of treatment options and close clinical monitoring of affected individuals.

Penile strangulation secondary to utilization of a constrictive ring is a rare urologic emergency that requires urgent decompression to prevent prolonged vascular obstruction resulting in necrosis and gangrene. Current literature is mainly comprised of case presentations that focus on management in the acute setting via removal of the ring. Herein, we describe surgical management of a patient who presents in delayed fashion after self-removal of the constrictive ring. We discuss our penectomy-sparing technique of debridement and split thickness skin graft.

Minimally invasive surgery is becoming the standard of care across surgical subspecialties. Several new \"minimally invasive\" options for burn debridement and autografting exist. Enzymatic bromelain-based debridement (BBD) and autologous skin cell spray (ASCS) have independently proven to reduce the rate of split-thickness skin grafting (STSG) and decrease donor site size when grafting is performed. There is a paucity in the literature regarding the combination of these two therapies. The purpose of this study is to characterize a cohort of patients treated with both BBD and ASCS and qualitatively compare data to expected outcomes without these therapies. This retrospective study of a single academic burn center\'s experience using BBD and ASCS together included 13 patients with a total burn surface area (TBSA) from 1-30% and all had >50% deep partial thickness. All patients received BBD and ASCS. Deeper burns additionally received STSG with ASCS overspray. Median burn size was 14% TBSA (IQR:5.45,20), donor site size was 225 sq cm (IQR:28.5,556.5), and ratio of donor site area to total treatment area of 0.082 (IQR: 0.039, 0.241) was observed. Median observed length of stay (LOS) was 19 days (IQR:10,27), expected LOS was 15.4 days, and O/E ratio 1.06. Donor sites in both groups of patients were much smaller than expected versus treatment with conventional meshed STSG alone and length of stay is lower than expected based on burn size. An emphasis on expenses and scar development will guide future studies into the patient subset and wound features that are best for this combination treatment.
La chirurgie mini-invasive devient le standard de traitement dans de nombreuses spécialités. Il y a de telles possibilités en brûlologie comme de débridement enzymatique à la bromélaïne (DEB) et la pulvérisation de cellules cutanées autologues (PCCA) qui ont chacun permis de diminuer le recours aux autogreffes et de réduire la surface de la zone donneuse. La littérature est pauvre en ce qui concerne la combinaison des 2. Cette étude rétrospective rapporte une cohorte de 13 patients traités dans notre centre par combinaison de DEB et PCCA, et compare le résultat avec celui attendu avec un traitement conventionnel. Les patients étaient brûlés sur 1 à 30% de SCT (médiane 14, IQR 5,45-20) dont au moins la moitié de 2ème profond, ayant tous reçu une combinaison de DEB et PCCA. Les atteintes plus profondes étaient greffées, avec une PCCA par dessus. Le site donneur avait une surface médiane de 225 cm2 (IQR 28,5-556,5) avec un rapport surface donneuse/surface traitée de 0,082 (IQR 0,039-0,241). La durée médiane de séjour est de 19 jours (IQR 10-27) quand elle était supposée être de 15,4 jours (rapport 1,06). Les sites donneurs étaient plus exigus que sous traitement conventionnel et la durée de séjour plus courte que supposée. Une étude plus précise sur les séquelles et les coûts permettrait de cibler plus précisément les patients susceptibles de bénéficier de ce protocole.

Background: Distal lower extremity reconstruction is challenging. This study aims to propose a protocol for the treatment of traumatic soft tissue defects. The key concept is to combine the surgical armamentarium of the reconstructive surgeon with the advantages provided by hyperbaric oxygen therapy. Methods: This retrospective study analyzed data of 57 patients affected with unilateral or bilateral lower extremity trauma distal to the knee and involving soft tissues with no indication of immediate reconstruction between 2010 and 2021. Before the reconstructive procedure, all the patients underwent a stick swab procedure for the collection of microbiological samples and debridement. Patients were divided into two treatment groups and only one group underwent a combined therapeutic procedure with hyperbaric oxygen therapy. Negative pressure wound therapy (NPWT) was employed only if deemed necessary according to the defect\'s depth and wound exudate. Surgical techniques, outcomes, and complications were discussed. Results: All patients achieved a complete recovery with no major complications and only minor complications observed. The study group treated with HBOT had a lower complication rate and lower percentages of minimal and partial graft loss compared with the same complications observed in the control group. No patients experienced HBOT-related complications. Significant reductions in the time to complete healing and the time from reconstruction to healing were found (p = 0.002 and p < 0.00001, respectively). Conclusions: A lower complication rate was observed in the group treated with HBOT. The administration of HBOT prior to soft tissue reconstruction significantly reduced the time to complete healing and the time interval from skin grafting to healing. However, prospective studies and randomized trials with larger cohorts should be designed to investigate the efficacy of HBOT for the treatment of lower extremity injuries with extensive soft tissue defects.

Split-thickness skin grafting (STSG) is a frontline treatment for challenging surgical wounds, including diabetic foot ulcers, venous leg ulcers, and post-surgical defects. This study explores the use of STSG employing the pinch graft technique for hard-to-heal surgical wounds following Mohs micrographic surgery (MMS). An 83-year-old patient with a non-improving post-MMS defect on the left lower leg underwent STSG from the right inner thigh using the pinch graft technique. The grafts were secured with a mesh dressing, adhesive strips, and compression bandaging. The patient experienced complete re-epithelialization and reduced pain within five weeks, emphasizing the efficacy of STSG for challenging cases. This case underscores the importance of considering STSG, especially in challenging locations, as a rapid and efficient treatment with improved quality of life. The pinch graft technique is presented as a useful option following MMS. This study encourages Mohs surgeons to consider STSG for reconstruction in challenging locations, especially on the lower leg.

Healthcare providers evaluating patients presenting with neurological, visceral, or cutaneous symptoms that are disproportionate to the expected severity may need to consider porphyria in the differential. Porphyria is an inherited condition in which toxic metabolites of the heme pathway are increased. Carriers of porphyrias are asymptomatic and will not present with classical symptoms, nor will levels be elevated, until the disease is induced by certain drugs, hormones, or idiopathic causes such as the stress of trauma. Acute intermittent porphyria (AIP), a form of acute porphyria, is a rare autosomal dominant disease that results in a dysfunctional porphobilinogen deaminase. This consequently increases neurotoxic porphobilinogen and subsequent increase in δ-aminolevulinic acid. Both of these metabolites cause neurovisceral symptoms that afflict the patient in acute attacks. We present a rare case of AIP manifested in a burn patient suffering a burn injury. The patient presented with symptoms indicative of AIP, including altered mental status and abdominal pain accompanied with a chronic history of alcoholism and smoking. A negative work-up, including imaging and findings of associated manifestations consistent with AIP led to a discovery of elevated porphyrins. The patient\'s course and death due to his injuries gives insight into the presentation of AIP in a burn patient.

UNASSIGNED: Hidradenitis suppurativa (HS) is a chronic skin disease that significantly reduces the quality of life of patients, especially affecting the intimate areas. Surgical treatment is one of the tools available for treating HS, which can significantly improve patients\' quality of life.
UNASSIGNED: To evaluate the surgical treatment of 31 patients treated surgically at the Centre for Burns Treatment in Sie-mianowice Śląskie, with a follow-up of 6 months.
UNASSIGNED: Thirty-one HS patients were operated on with classical reconstructive methods. The patients were followed up for 6 months in the outpatient clinic. We gathered clinical data of 31 post-operative patients and statistical analysis was performed.
UNASSIGNED: 83.87% of the patients were completely healed. The study showed that HS recurrence in the surgical site occurred in 1 (3.23%) patient only after 6 months of follow-up. We found a statistically significant (p < 0.050) positive correlation between patients\' age and body mass index (BMI), disease duration and time of diagnosis. BMI value additionally correlated with disease duration and time of diagnosis, while disease duration correlated with time of diagnosis.
UNASSIGNED: Surgical treatment is an effective method in HS. The relatively low recurrence rate after 6 months and, in most patients, full healing, support the good therapeutic effect of surgical treatment.

BACKGROUND: Whilst there is a trend away from aggressive nonorgan sparing surgical treatments for malignant penile disease, a variety of penile preservation options exist but functional outcomes and patient reported outcomes (PROs) in this area are poorly reported to date.
OBJECTIVE: The aim of this study is to report functional outcomes and PROs of total glans resurfacing (TGR) in a consecutive series of patients with lichen sclerosis (LS) or localized penile cancer (PC).
METHODS: From 2004 to 2018 a consecutive series of patients underwent TGR for the management of LS or localized PC in a tertiary referral network. Patient clinical records and operative notes were retrospectively reviewed. Statistical analysis was conducted with Stata 12.
RESULTS: Urinary and sexual outcomes were recorded utilizing both the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) validated questionnaires while PROs were extrapolated from a 5-item \"ad hoc\" telephone questionnaire administered at 1 year post procedure.
RESULTS: 37 consecutive patients were enrolled. Histology results demonstrated LS in 16 patients, with the remaining 21 having a diagnosis of PC. The most common reasons for patient presentation were local pain (32.4%), pruritus (37.8%) and bleeding (29.7%). Median follow-up was 22 (IQR 13-77) months. Median age was 62 (IQR 55-68).Neither of the questionnaires assessing urinary and sexual function showed any significant deterioration after surgery. Glans sensitivity was fully maintained in 89.2% of cases. 94.5% of patients reported to be fully satisfied with the aesthetic appearance of the penis and would consider undergoing the same procedure again if necessary. 91.9% of patients would recommend the same procedure to someone else. An overall improvement of the quality of life was reported by 86.4% of patients.
CONCLUSIONS: TGR should be considered a treatment of choice for selected cases of benign or malignant penile lesions.
UNASSIGNED: Our study has some limitations, the first being its retrospective nature. Furthermore, despite being one of the largest series to date, follow-up duration is somewhat limited and a control group is lacking.
CONCLUSIONS: TGR represents an excellent surgical option ensuring satisfactory voiding and sexual function, as well as cosmesis for selected cases of penile lesions.