title: Delayed grafting for banked skin graft in lymph node flap transfer.
abstract: Over the last decade, lymph node flap (LNF) transfer has turned out to be an effective method in the management of lymphoedema of extremities. Most of the time, the pockets created for LNF cannot be closed primarily and need to be resurfaced with split thickness skin grafts. Partial graft loss was frequently noted in these cases. The need to prevent graft loss on these iatrogenic wounds made us explore the possibility of attempting delayed skin grafting. We have herein reported our experience with delayed grafting with autologous banked split skin grafts in cases of LNF transfer for lymphoedema of the extremities. Ten patients with International Society of Lymphology stage II-III lymphoedema of upper or lower extremity were included in this study over an 8-month period. All patients were thoroughly evaluated and subjected to lymph node flap transfer. The split skin graft was harvested and banked at the donor site, avoiding immediate resurfacing over the flap. The same was carried out in an aseptic manner as a bedside procedure after confirming flap viability and allowing flap swelling to subside. Patients were followed up to evaluate long-term outcomes. Flap survival was 100%. Successful delayed skin grafting was done between the 4th and 6th post-operative day as a bedside procedure under local anaesthesia. The split thickness skin grafts (STSG) takes more than 97%. One patient needed additional medications during the bedside procedure. All patients had minimal post-operative pain and skin graft requirement. The patients were also reported to be satisfied with the final aesthetic results. There were no complications related to either the skin grafts or donor sites during the entire period of follow-up. Delayed split skin grafting is a reliable method of resurfacing lymph node flaps and has been shown to reduce the possibility of flap complications as well as the operative time and costs.
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.|PhD Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung, Taiwan.|Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung, Taiwan.
authors.forename: Pedro
authors.initials: P
authors.lastname: Ciudad
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Shivprasad
authors.initials: S
authors.lastname: Date
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Georgios
authors.initials: G
authors.lastname: Orfaniotis
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Rory
authors.initials: R
authors.lastname: Dower
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Fabio
authors.initials: F
authors.lastname: Nicoli
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Michele
authors.initials: M
authors.lastname: Maruccia
authors.affiliation: Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung, Taiwan.
authors.forename: Shu-Ping
authors.initials: SP
authors.lastname: Lin
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chu-Yi
authors.initials: CY
authors.lastname: Chuang
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Tsan-Yu
authors.initials: TY
authors.lastname: Chuang
authors.affiliation: PhD Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung, Taiwan.|Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung, Taiwan.
authors.forename: Gou-Jen
authors.initials: GJ
authors.lastname: Wang
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps / Q000637:transplantation*; D013997:Time Factors; D014015:Tissue Banks; D016896:Treatment Outcome; D034941:Upper Extremity / Q000601:surgery*
keywords: Banking split thickness skin graft; Delayed skin grafting; Lymph node flap transfer; Lymph node transfer; Lymphoedema
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