Treating complex palmar–plantar wounds using a bilaminar ‘trapdoor’ technique: a case series

Abstract

Objective: Due to the similarities of glabrous skin, the plantar region is an excellent donor area for covering complex palmar–plantar wounds. However, taking grafts from the plantar area often results in significant morbidity at the donor site or non-integration of the graft due to the greater thickness of the plantar corneal layer. Method: This is a prospective case series including patients with burns or wounds who have been treated with a dermal graft using the bilaminar ‘trapdoor’ technique. This procedure is used to remove a thin graft from the deep plantar dermis after the partial elevation of the first layer including the entire epidermis and superficial part of the dermis. Results: At the donor area in the four patients in this case series, we observed healing at around 10 days, and absence of hypertrophic scar in all patients. There was complete re-epithelialisation between two and three weeks from the periphery to the centre of the deep dermal graft, and from the glandular epithelium transferred with the graft. During the follow-up, patients presented aesthetic and functional features of glabrous and amelanotic skin, with similar resistance to those of the adjacent areas of the wound in the palmar–plantar region. Conclusion: This technique has some advantages, such as less surgical time, minimal morbidity in the plantar donor area, easy integration of the grafts, and maintenance of the functional and aesthetic properties of glabrous skin both in the plantar donor area and in the palmar–plantar recipient region. Declaration of interest: The authors have no conflicts of interest to declare.