SkinDot: A modified full-skin transplantation technique.

Existing epidermal transplantation procedures applied in burn surgery or wound treatment, such as mesh grafting or the Meek method, do not lead to a restoration of all the skin layers. Dermal skin layers are indispensable in ensuring the quality and function of the transplanted skin as a frictional surface and a carrier of skin appendages such as hair, sweat glands, and sebaceous glands, as well as nerve receptors for detecting pressure, vibration, and temperature. Because of the restricted skin surface area that can be provided by the donor, full-skin transplants cannot be transplanted over a large area. Cultured skin procedures, based on skin cells cultivated in a laboratory, have not yet reached a stage of development where a complex full epidermal transplantation is possible. In particular, the introduction of skin appendages with a functional cell-to-cell communication has not been observed thus far in cultivated skin. Based on the Reverdin transplantation method, in which concave skin islands with epidermal and dermal parts are transplanted, Davis in 1910 described the transplantation of multiple 2-5 mm sized full-skin islands as a new method for the treatment of skin lesions. Further modifying this 100-year-old procedure, we developed a miniaturization and automation of the Davis transplantation method that started in 2011 and called it "SkinDot". In the following article we describe the effectiveness of the full-skin island transplant procedure in two patients. The transplantation of single 2-3 mm full-skin islands results in a full-skin equivalent without any limits on donor area and with a reduced donor morbidity.

When Is It Appropriate to Put a Live Donor at Risk to Help Another Patient?

This article considers the nature and scope of ethical decision making in monozygotic sibling (MZS) skin grafting. Although rare, identical twin-to-twin skin grafting has been reported with excellent survival rates in burn patients. Of 16 cases published to date, only a few address the ethical decision making process that is involved with monozygotic sibling skin grafting; this article discusses clinical indications and ethical challenges.

Ethics of Burn Wound Care in a Low-Middle Income Country.

This review focuses on burn care in low- and middle-income countries (LMICs). It attempts to put the burden of disease in perspective by showing that burn care is under-resourced across the spectrum of LMICs and by interrogating the ethical dilemmas and challenges that staff face in caring for burn patients in this environment, with a focus on South Africa. More specifically, it will attempt to address the following issues: the threshold for utilizing the intensive care unit (ICU), how to balance treatment against cost, the percentage burn considered survivable and how it should be determined, the use of skin from both cadavers and living related donors, and the appropriate ethical guidelines for LMICs.

Surgical results, aesthetic outcome, and patient satisfaction after microsurgical autologous breast reconstruction following failed implant reconstruction.

BACKGROUND: The majority of breast reconstructions are performed using implant material. Implants have some major long-term disadvantages. Long-term implant-related complications and improved microsurgical techniques have led to an increased number of women requesting conversion of their implant breast reconstruction to autologous breast reconstruction. The aim of this study was to evaluate surgical and aesthetic outcome and patient satisfaction after tertiary autologous breast reconstruction. METHODS: Between 2001 and 2007, 42 women underwent 61 tertiary autologous breast reconstructions. Surgical outcome and complications were evaluated. Patient satisfaction was assessed using a study-specific questionnaire. Aesthetic result was rated by an expert panel using standardized photographs. RESULTS: Forty-seven deep inferior epigastric artery perforator, 10 mini-transverse rectus abdominis musculocutaneous, and four transverse musculocutaneous gracilis flaps were performed. Eight patients required reoperation because of complications (19 percent). Total flap loss did not occur. Nineteen patients underwent one or more additional operations to improve aesthetic outcome. Physical discomfort caused by implants and dissatisfaction with the aesthetic result were the main patient motivations to opt for autologous breast reconstruction. Reduction or disappearance of physical discomfort was noted in the vast majority of patients. Most patients were very satisfied with the aesthetic result (mean, 8 of 10), but the mean panel satisfaction score was lower (7 of 10). However, the panel noted a significant improvement of the aesthetic result after conversion to autologous breast reconstruction (from 5 of 10 to 7 of 10). CONCLUSION: Autologous breast reconstruction after failed implant reconstruction is a technically feasible and reliable procedure that leads to improved physical condition and aesthetic results and a high degree of patient satisfaction.

Until they have faces: the ethics of facial allograft transplantation.

The ethical discussion of facial allograft transplantation (FAT) for severe facial deformity, popularly known as facial transplantation, has been one sided and sensationalistic. It is based on film and fiction rather than science and clinical experience. Based on our experience in developing the first IRB approved protocol for FAT, we critically discuss the problems with this discussion, which overlooks the plight of individuals with severe facial deformities. We discuss why FAT for facial deformity is ethically and surgically justified despite its negative portrayal in the media.