Reverdin skin grafting as adequate approach for squamous cell carcinoma of the temporal region

Abstract

Dear Editor, There has been a significant evolution in skin grafting techniques over the past 200 years from Reverdin pinch grafting to modern day meshed skin grafts using powered dermatome (Singh, Nuutila, Collins, & Huang, 2017). In fact, the idea of Reverdin skin grafting was born in 1869 by Jaques-Louis Reverdin, a young Genevan (Ehrenfried, 1909). Over time, the Reverdin pinch graft technique has become an easy and effective closure option for medium–large surgical defects after nonmelanoma skin cancer excision, according to literature data, the average healing time after is 4 ± 1.12 weeks (Hofmann, Hameed, Schleussinger, & Lawrence, 2018). We present a 93-year-old man with a complaint about the appearance of a tumor formation in the right temporal area with about 1 year duration, which gradually increased in size (Figure 1). During the dermatological examination, a nodular brown formation with erosive surface covered with cruciforms and the presence of bleeding on contact was visualized in the right temporal area (Figure 1). Clinically, the lesion was suspected for spinocellular carcinoma. In parallel, the presence of a tumor-like formation with a centrally located cruciform was found in the right hand area. The formation in the right temporal region was surgically removed by an oval excision with a safety margin of 5 mm in all directions (Figure 1b–d). The subsequent histological verification confirmed the initial diagnosis, namely that it was a nonekeratinized squamous cell carcinoma with a maximum tumor diameter of 30 mm and single tumor emboli. Staging established T2N0M0 spinocellular carcinoma. Two weeks after the removal of the primary tumor and daily dressing, disinfection, and descaling (Figures 1 and 2), the so-called Reverdin skin grafting was performed, with skin fragments taken from the abdominal area (Figure 2) and transplanted to the surgical defect in the right temporal region in the form of separate islands with a distance of 5 mm in the type of split-thickness skin graft (Figure 2b). It was started by local anesthesia with lidocaine in the abdominal area, lifting with a sterile curved needle and tangential separation with a scalpel of fragments of skin (Figure 2a), which were immediately placed in sodium chloride for 10 min immediately after separation. In the next stage, the operative wound in the right temporal region was subjected to lidocaine anesthesia and curettage, which led to a slight bleeding-suppressed with а sterile gauze, after which the island tissues were transplanted in the form of chessboard and fixed with compression for 6 days (Figure 2b). Daily dressings and cleaning of the adhesive and partially necrotic islands followed, resulting in a gradual formation of granulation tissue and closure of the operative defect (Figure 2c–e). In parallel with the removal of the formation in the temporal region, an elliptical excision of the lesion on the back of the right hand was performed (Figure 3b–d). The histological examination revealed data for cornu cutaneum. Analyzing the surgical lessions of Billroth and his practice, Reverdin observed that islands with epithelium sometimes formed in the center of the granulation tissue in patients with burns (Singh et al., 2017). He acknowledges that the appearance of these islands of epithelial tissue occurs in spots where the deep dermis layers have been spared and that these islands significantly accelerated healing (Montandon, 2015; Singh et al., 2017). Based on these analyzes, Reverdin expressed the theory that this process can be mimicked by placing small fragments of living epidermis on the surface of a granulating wound, with the idea that it stimulates the formation of granulation tissue islands (Ehrenfried, 1909; Klasen, 1981; Montandon, 2015). Within days, he proved his hypothesis by placing pieces of his skin on the granulating wound of one of his patients, and after a few days he observed that these small pieces were solidly adherent and around them new skin was forming, growing day after day at a distance from the borders of the wound (Montandon, 2015). When choosing the best alternative for wound closure, autologous skin grafts are commonly considered as the gold standard (Valencia, Falabella, & Eaglstein, 2000). The most commonly used skin graft donor areas are the volar surface of the forearm and the extensor surface of the thigh, but it is recommended that they should be avoided where possible due to the presence of long-term esthetic implications (Rigg, 1977). In this respect, it is recommended that the choice of donor site should be appropriate to the type of graft and patient s age and sex (Rigg, 1977). It is thought that the closer the donor site is to the defect, the better the color and texture match, as a graft taken from skin adjacent to the surgical defect, known as Burrow s graft often provides an ideal match with respect to both color and texture (Coban, Aytekin, & Tenekeci, 2011). However, donor sites can be virtually anywhere in the body (Coban et al., 2011). Retrospective and prospective clinical studies have shown that mesh grafting of small split-skin donor sites in the elderly can accelerate the rate of healing compared to the “unmeshed” area, demonstrating the advantage of the methodology (Fatah & Ward, 1984). Received: 2 December 2019 Accepted: 16 December 2019