Glabrous skin reconstruction of palmar/plantar defects: A case for reconsideration
AbstractBackground: One basic fact about a Negroid race is that the nonglabrous skin is much more pigmented compared to the glabrous skin. A major disadvantage of nonglabrous skin grafts when used for reconstruction of palmar/plantar defects is the poor cosmetic appearance of the grafted skin. Aside from its normalcy of appearance, glabrous skin grafts yield superior results with improved function and sensation, and increased durability.
Aim: To provide skin cover of palmar/plantar defects with acceptable cosmetic appearance.
Methods: A prospective descriptive study of consecutive patients with benign soft tissue palmar/plantar defects seen at the Usmanu Danfodiyo University Teaching Hospital, Sokoto over a 3 year period from January 2001 to December 2003. Split thickness glabrous skin was harvested either from the ulnar surface of the palm of the hand or from the instep of the foot using a pre-sterilized ordinary razor blade held on a straight artery forceps and laid on the wound surface.
Results: A total of 51 limbs in 49 patients were studied. There were 7 males and 42 females giving a male: female ratio of 1: 6. The ages ranged from 4 months to 26 years (mean = 11.4 years). Indications for grafting were for correction of flexion contractures in 33 (63.3%) limbs, and to cover granulating wounds in the remaining 18 (36.7%). Of the 51 limbs grafted, 43 (84.3%) involved the hands while the remaining 8 (15.7%) involved the feet. Graft take was over 85% in 44 (86.3% ) limbs, and all patients had excellent cosmetic outcome. Of the 49 patients, 38 (77.6%) were managed as inpatients. The duration of hospital stay ranged from 3 to 17 days (mean = 9.2 days).
Conclusions: Glabrous skin graft is a simple procedure that can be accomplished with minimal facilities and training. It offers excellent cosmetic results when used in covering suitable soft tissue defects of the sole of the foot or the palm of the hand in blacks.
Keywords: glabrous skin, palmar/plantar defects, black population
Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 168-172