A new method of full thickness skin graft fixation.

Mehta, Hemant

doi:10.1136/bjo.63.2.125

Cited by 24 publications

(22 citation statements)

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“…4A-D Fig. 4 (A) Keratoacanthoma oftwo years' duration, affecting the right lower eyelid ofa Caucasian male aged 71. The excision was asymmetrical in that the cutaneous lamellar excision extended 8 mm downwards from the lid margin and was 13 mm in horizontal extent.…”

Section: Methodsmentioning

confidence: 99%

Simultaneous spontaneous and primary surgical repair of eyelids.

Mehta¹

1989

British Journal of Ophthalmology

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The potential of the lower and upper eyelids individually-each on its own-to yield a nearly normal functional and cosmetic result solely by spontaneous repair after a moderate sized fullthickness margin-inclusive (FTMI) excision has been established.'2 Before that it had long been known that a competent primary and in-toto surgical reconstruction after such FTMI excisions also produces near normal results. So far the combined management by primary surgical reconstruction of part of the excised area and simultaneous spontaneous repair of the residual defect has not been reported. This study demonstrates the results of such combined management after moderate to large FTMI excisions of the lower eyelid, and large deep excisions of inner canthal skin and orbicularis with contiguous FTMI

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Section: Methodsmentioning

confidence: 99%

Simultaneous spontaneous and primary surgical repair of eyelids.

Mehta¹

1989

British Journal of Ophthalmology

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“…large graft whose take may seem precariou imposes even more stringent restrictions. I the past few years a new technique has been c (Mehta, 1977(Mehta, , 1979 for full-thickness skin fixation, Fig. 1 Orhbit:al1 s ep t vim 20x 55 mm.…”

Section: Full-thickness Skin Graftingmentioning

confidence: 99%

Surgical management of carcinoma of eyelids and periorbital skin.

Mehta¹

1979

British Journal of Ophthalmology

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SUMMARY An appraisal of a personal series of 115 unselected and surgically treated cutaneous cancers of palpebral region is presented. Histological confirmation of the diagnosis and adequacy of excision was obtained for all lesions. Seven of the 8 patients with doubtful clearance were successfully treated with further surgery very soon. Complications were few, the incidence of reoperations low, and cosmetic as well as functional results were mostly satisfactory. Tumour recurred in 1 case (087%). Two patients had a poor cosmetic result. Seventy-nine cases (69%) were treated as day cases under local anaesthesia even for major repairs like full-thickness reconstruction of two-thirds of the lower eyelid and repairs with large full-thickness skin grafts of up to 20 x 55 mm by a new simple technique of graft fixation. The use of longer-acting local anaesthetics in oculoplastic surgery is described. Attention is drawn to the dangers of using direct wound closure for repair.

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“…1 One of the most important factors to ensure successful vascularization is the maintenance of a firm and constant approximation between the graft and the recipient bed for the first postoperative week and good immobilization of the graft. 2 Mobility or fluid accumulation may predispose patients to infection and contracture, with partial or total loss of the graft.…”

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confidence: 99%

“…Only one article addressed this technique in detail and its use in ophthalmic plastic surgery; this article was not in the American literature. 2 This technique anchors the skin graft with a combination of peripheral and central sutures. These can then be passed through a Xeroform gauze pad (Baxter Health Care, McGaw Park, Illinois) or other similar material to provide uniform pressure over the graft (Fig.…”

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Surgical Technique

Naugle¹,

Lee²,

Couvillion³

2004

Ophthalmic Plastic & Reconstructive Surgery

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Goals for a successful skin graft include vascularization of the graft and prevention of fluid accumulation between the graft and recipient bed. Excessive accumulation of serosanguinous fluid between a skin graft and its recipient site can result in excessive pain, edema, and hematoma with or without partial or total graft failure. Full-thickness skin grafts vascularize by anastomoses between vessels of the graft and host at the base of the wound rather than from the wound edges. 1 One of the most important factors to ensure successful vascularization is the maintenance of a firm and constant approximation between the graft and the recipient bed for the first postoperative week and good immobilization of the graft. 2 Mobility or fluid accumulation may predispose patients to infection and contracture, with partial or total loss of the graft.Many immobilization techniques in addition to perimeter sutures have been described, most of which use extrinsic mechanical devices. These techniques include pressure dressings, tie-over bolsters, and adhesives such as glues and Steri-strips. Many of these techniques are problematic and may result in less-than-optimal results in complicated cases. Ocular pain and trauma can prohibit the use of pressure dressings around the globe. Perimeter sutures at the graft/recipient site, tied over a bolster, can create or enhance ectropion in the periocular area, leading to dryness and epiphora. Additionally, an elevated ridge of tissue at the graft/recipient site may result as the edges of the surgical defect are pulled away from the underlying tissue. Glues and Steri-strips may loosen and not provide uniform pressure during the healing process.We propose that quilting sutures placed in the recipient bed with or without Xeroform bolsters can aid in preventing these problems. We performed an extensive literature search involving more than 50 texts and 20 journal articles related to this topic. Only one article addressed this technique in detail and its use in ophthalmic plastic surgery; this article was not in the American literature. 2 This technique anchors the skin graft with a combination of peripheral and central sutures. These can then be passed through a Xeroform gauze pad (Baxter Health Care, McGaw Park, Illinois) or other similar material to provide uniform pressure over the graft (Fig. 1). More direct visualization of the suture entrance can be gained by passing sutures in the recipient bed prior to their passage through the graft, and, if present, a bolster. Figure 2 illustrates a patient immediately after receiving a Xeroform bolster. The imprint covering the entire graft suggests that uniform pressure was imparted by the bolster. Figure 3 illustrates the postoperative result, with no discernible graft scar.We retrospectively studied the charts and photographs of 30 patients who had undergone free skin graft surgery around the eye. The senior author performed 15 surgeries using only the perimeter sutures, and 15 surgeries using the quilting suture technique. One half of the ca...

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A new method of full thickness skin graft fixation.

Cited by 24 publications

References 0 publications

Simultaneous spontaneous and primary surgical repair of eyelids.

Simultaneous spontaneous and primary surgical repair of eyelids.

Surgical management of carcinoma of eyelids and periorbital skin.

Surgical Technique

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