British journal of plastic surgery
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Recovery of cold, warmth and heat-pain sensations in skin grafts was studied psychophysically in 22 patients who had had split skin grafts transplanted over muscle fascia 1 to 4 years earlier. A thermal stimulator based on the Peltier principle and controlled by a microprocessor was used to measure the thermal sensitivity of the grafts. Control measurements were obtained from the corresponding opposite side of the body. ⋯ Heat-pain sensitivity was present in 8 grafts. If the warmth and heat-pain sensibility had recovered, the sensation threshold was closer to the normal value than that for cold. In 7 grafts (from 1-3 years) no recovery was obtained.
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Clinical Trial Controlled Clinical Trial
Calcium alginate dressing accelerates split skin graft donor site healing.
A prospective controlled trial of calcium alginate compared with traditional dressing of paraffin gauze on split skin graft (SSG) donor sites had to be abandoned after 15 patients as there was consistently better healing under the calcium alginate. The study was continued, on every patient requiring split skin grafting, to assess calcium alginate from the point of view of patient comfort, ease of dressing and quality of regenerated skin. In 107 patients with 130 SSG donor operations, there was a statistically highly significant decrease in average time to complete healing (from 10 down to 7 days), and also significantly better patient comfort. The alginate dressings were easy to use and the quality of the new skin significantly better than that seen under paraffin gauze dressings.
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Case Reports
The fate of meshed allograft skin in burned patients using cyclosporin immunosuppression.
Three patients with burns of 35%, 60% and 25% were treated with cyclosporin after the application of allograft skin. Biopsies of the allografts were taken at appropriate intervals. The drug was continued for 3 weeks, 3 months and 3 weeks respectively without ill-effects on the patients. ⋯ In Case 3 where a meshed auto/allograft 'sandwich' technique was used, there was no visible evidence of rejection. It is likely that the allograft was replaced by a "creeping substitution" in the sandwich technique. The Langerhans cell is probably not solely responsible for allograft rejection.
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Biography Historical Article
The legacy of the giants (Gillies memorial lecture 1985).
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Randomized Controlled Trial Comparative Study Clinical Trial
Split skin grafting using topical local anaesthesia (EMLA): a comparison with infiltrated anaesthesia.
The analgesic efficacy of EMLA cream was compared with that produced by infiltration of lignocaine solution when used to provide anaesthesia for cutting of skin grafts. The study was performed as an open parallel group comparison in 80 patients. ⋯ On administration, infiltration produced varying amounts of pain in all patients, but in contrast EMLA produced no discomfort. In view of this lack of discomfort and the consequent greater freedom afforded regarding the area of donor site anaesthetised, EMLA can be considered the treatment of choice when skin grafts are harvested under local anaesthetic.