Abstract: Development of an Algorithm for Prevention of Dermatome-Induced Lacerations: Incidence, Management, and Preventive Measures

Abstract

INTRODUCTION: Dermatome-induced laceration is a known complication but there is a paucity of literature discussing the incidence or the predisposing factors. The aim of this study was to determine the incidence rate and identify those risk factors in order to develop an algorithm for residents to improve patient safety. METHODS: An 18-question survey was sent to all Burn Unit Directors in the US and Canada investigating the type and location of practice, average annual caseload of skin graft harvesting, number of dermatome-induced lacerations, donor site location, harvesting technique and equipment, severity of laceration, etiology and patient related factors. RESULTS: A total of 56 responses (42% response rate) were received from Burn Unit Directors in the US and Canada. A total of 133 lacerations were reported for the prior 5 years. The overall incidence of dermatome-induced lacerations was calculated at 0.1% per year (1.3 per 1,000 cases). The most common causes were excessive pressure with the dermatome (25.7%) and patient-related factors (18.9%) such as skin laxity (23%) and age (17.6%). Most lacerations occurred when the skin graft were harvested from the thigh (77%) with assistance of mineral oil (75.7%) as a lubricant, and by using a Zimmer air dermatome (73%) with a 4 inches guard (63.5%), 0.010–0.015 inches thickness (78.4%), and 30–45 degrees angulation (47.3%). CONCLUSION: According to this study, dermatome-induced lacerations are rare events. However, every step should be taken to prevent them starting from proper identification of patients at risk, proper set up and use of the dermatome.