Advancements in skin grafting: Development and application of a novel two-blade dermatome for concurrent split-thickness and dermal graft harvesting

Abstract

This investigation delineates the evolution and prospective utilisation of an innovative two-blade dermatome, designed for the concurrent harvesting of a conventional split-thickness skin graft (STSG) and an additional dermal graft within the same surgical harvest. Historically, the extraction of dermal grafts has encountered substantial technical impediments, contributing to its limited acceptance and utilisation in clinical practice. The prototype dermatome, introduced in this technical note, offers a solution that could facilitate the more extensive adoption of dermal grafting techniques.The dermal segment of an STSG, obtained as a second graft, confers four notable advancements: First, employing solely the dermal component for grafting and repositioning the uppermost skin flap to the donor site, markedly diminishes donor site morbidity. Second, owing to its elasticity, the dermal graft reduces the need for meshing, thereby enhancing cosmetic outcomes. Third, utilising both the uppermost skin layer and a deeper dermal layer for the recipient site can reduce donor site areas. Fourth, the dermal segment of the graft can serve as a dermal matrix in reconstructive procedures, potentially reducing the need for an allogenic dermal matrix and obviating the subsequent STSG; the dermal graft may heal independently, eliminating the need for an additional conventional STSG.The findings of this study, predicated on the application of a first-generation two-blade dermatome on four cadavers, demonstrate the feasibility of extracting at least two distinct grafts with pre-determined thicknesses in a single, technically less challenging, surgical harvest procedure.In conclusion, this proof-of-concept research elucidates the feasibility of a two-blade dermatome, capable of simultaneously yielding at least one conventional STSG and one dermal graft, thereby simplifying skin graft harvesting. Although these preliminary investigations were conducted on human cadavers, the results hold promise for the development of two-blade dermatomes and represent a significant advancement in skin graft harvesting. Further research is imperative to refine the prototype and to broaden our comprehension of the potential applications of dermal grafting in various clinical scenarios.