PMC2772268_01
(a) A pre-operative photo of Marjolin.s ulcer at the right popliteal fossa; (b) An intra-operative photo after tumor excision with exposed neurovascular structures; (c) Two weeks post operation day; (d) Two weeks post secondary suturing of the wound
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F0001
A 56-year-old female presented with Marjolin's ulcer at the back of her right knee secondary to a chronically non healing burn wound [Figure 1a]. A wide resection was done and a free latissimus dorsi myocutaneous free flap was required to cover the defect due to exposed neurovascular bundles [Figure 1b] and post-operative radiotherapy was planned. By this time, the skin allograft had partially sloughed off, the wound bed was healthy and filled with granulation tissue, and there was wrinkling of the surrounding skin indicating resolved edema [Figure 1c]. This provided a better aesthetic outcome and avoidance of split skin graft to provide more robust and stable tissue for radiotherapy, and a better scar across the knee joint [Figure 1d].
PMC2772268_02
(a) Pre-operative giant cell tumor of left distal radius and carpal bones; (b) Preoperative following resection of the tumor; (c) Immediate postoperative with flap insetted; (d) Forty-eight hours post operative-flap congested due to venous thrombosis; (e) Two weeks after emergency exploration with GPA in situ and well adhered, and evidence of resolved edema with surrounding skin wrinkles; (f) One week after secondary suturing
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F0002
A 43-year-old male presented with a massive giant cell tumor involving the distal end of the left radius and the first row of the carpal bones [Figure 2a]. A wide resection of the tumor was performed [Figure 2b] followed by reconstruction with a free fibula osteocutaneous flap. Fusion of the wrist joint was performed in the same setting [Figure 2c]. Twenty-four hours later, venous congestion was noted secondary to pedicle compression from local edema, which developed post operatively despite limb elevation [Figure 2d]. A GPA was used as a biological dressing for 10 days to allow the edema to subside and to protect the exposed tendon from desiccation [Figure 2e]. Secondary suturing was done at that stage, which provided a better aesthetic outcome compared with a split skin graft if it had been done at the time of flap exploration [Figure 2f].
PMC2772268_03
(a) Left hand crush injury due to sugarcane juicer machine; (b) GPA applied to the wound after first debridement; (c) Ten days after debridement with GPA well adhered and small patchy area of devitalized tissue becomes apparent
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F0003
Most of his fingers were non-viable at presentation with bone loss [Figure 3a]. All viable tissues were preserved and temporarily covered with a GPA [Figures 3b and 3c] and vacuum assisted closure dressing (VAC ).
Left hand crush injury after debridement and pretreatment with GPA; (a). Immediate post-operative view after reconstruction with anterolateral thigh fasciocutaneous free flap, partial closure, and GPA application; (b) and (c). Three months and 1 year after secondary suturing of the flap
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F0004
A GPA was needed to aid in wound closure without tension [Figure 4a]. The patient recovered well but refused a secondary reconstruction as he had adapted well and had resumed work [Figures 4b and 4c].