34 | SMART SURGERY FOR SPECIFIC ANATOMICAL DISTRICTS

M. Donini | U.O.C. Dermatologia, Ospedale Civile Venezia, Italy

Smart Surgery for Specific Anatomical Districts S.E.M.I. Technique (Skin Extension by Multiple Incisions) This surgical approach enables the approximation of wound margins, even in the presence of substantial tissue loss, without necessitating technically complex local flaps. The procedure involves executing a series of mini-incisions, measuring 3 to 5 mm in length, oriented parallel to the long axis of the surgical defect. These incisions are performed sequentially until the traction tension exerted on the margins is adequately minimized. Each individual incision must extend precisely to the subcutaneous adipose tissue layer. Progression of the mini-incisions is halted once tissue tension is reduced within physiological limits. The cumulative average area of the incisions is approximately 2.5 times the area of the primary surgical defect. This technique has been predominantly applied to defects located on the ankle, foot, lower leg, and forearm. Clinical Advantages of the S.E.M.I. Technique: Tactile Sensitivity: No significant loss of tactile sensitivity compared to the surrounding skin has been observed postoperatively. Deep Tissue Adhesions: No structural adhesions to deep anatomical layers (including tendons, muscles, or bone) have been reported. Donor Site Preservation: Complete absence of scarring correlated with a skin donor site, eliminating secondary morbidity. Comparative Analysis: S.E.M.I. vs. Free Skin Grafts - Vascular Integrity: Demonstrates a lower risk of vascular compromise at the recipient site. - Aesthetic Preservation: Eliminates the necessity of harvesting tissue from a separate donor site, optimizing overall cosmetic outcomes. - Local Tissue Harmony: Yields a superior localized aesthetic result by utilizing identical adjacent cutaneous tissue from the margins of the surgical defect. - Postoperative Course: Associated with a significantly faster and less complicated postoperative recovery period. - Surgical Efficiency: Characterized as a more rapid and straightforward operative technique. Comparative Analysis: S.E.M.I. vs. Local Flaps - Vascular Safety: Presents a lower risk of localized vascular suffering compared to specific transposition or advancement flaps. - Complication Rates: Minimizes the risk of surgical complications due to the strict absence of extensive tissue undermining. - Cosmetic Outomes: Provides a superior aesthetic result compared to certain conventional local flaps (e.g., transposition flaps). - Operative Versatility: Operates as a simple and adaptable technique.