313 Dermatome-Induced Lacerations: Incidence, Management, and Preventive Measures

Abstract

Dermatome-induced lacerations are a known complication; however, there is a paucity of literature discussing the incidence and predisposing factors. The aim of this study was to determine the incidence and risk factors in order to develop a preventive algorithm. An 18-question survey was sent to all U.S. and Canadian burn unit directors. Surgeons were queried about type and location of their practices, average annual caseload of skin graft harvesting, and number of dermatome-induced lacerations. The survey also asked about donor site location, harvesting technique and equipment, laceration severity, and causative factors. An algorithm was developed based on the results and the current manufacturers’ guidelines. Fifty-six responses (42% response rate) were received from the burn unit directors. They reported 133 lacerations over the past 5 years. The overall incidence of dermatome-induced lacerations was 0.1% per year (1.3 per 1,000 cases). The most commonly attributed causes were excessive pressure (25.0%) and patient factors (18.4%). Most lacerations occurred when using air dermatomes (73.0%) with a 4-inch guard (63.5%), 0.010-0.015-inch thickness (78.4%), and 30–45° angulation (47.3%); the most common brand was Zimmer (71.6%). The dermatome was typically set up by a scrub tech/nurse (48.6%), while the skin harvesting was performed by residents (39.2%) or attendings (35.1%). Lacerations typically extended to subcutaneous tissue (70.3%), with no neurovascular injury (86.5%). Our study showed that dermatome-induced lacerations are rare events and that certain factors predispose patients to injury. An algorithm was developed to provide guidance on risk factor identification and the set up and use of dermatomes. This study provides the only evidence on the incidence, etiology and risk factors of dermatome-induced lacerations. The development of an algorithm will help to increase the safety of skin grafting, the most commonly performed procedure in burn surgery.