Open method of free skin grafting

Abstract

Methods of free skin grafting are the open, closed and intermediate methods. Important factors to be considered in the open method are as follows: (1) Epidermis has no direct blood supply but lives on tissue fluid. We attempt to set the stage so that ever flowing springs of tissue fluid seep from the body into the free skin graft. (2) Clot is body glue. We depend upon the adhesive qualities of the clot to stick the graft to the body and not to bandages in an attempt to achieve the same result. (3) Secondary tissue is substitute tissue. Ideally in secondary healing wounds we discard it; practically this is not always advisable. (4) Protection of the properly applied graft is the essence of success in free skin grafting. This may be accomplished with and without bandages. (5) Success in free skin grafting by the open method proves that control of edema by bandages is erroneous or, if true, is unimportant. (6) Complete immobilization is not necessary for success in free skin grafting. Soft undulating movements are not harmful because the graft is held to the recipient area by elastic clot. (7) Any area not subject to trauma or which can be protected from trauma and which is not subject to acute or twisting movements can be treated by the open method. (8) Color changes noted in the free skin grafts during the course of healing are probably due to variations in the thickness of the grafts and changes in the recipient area. (9) Donor sites are not bandaged but are openly protected until dry. (10) Advantages of the open method of treating free skin grafts, open wounds and donor sites are reflected in the limited use of hospital personnel, hospital equipment and bandages. (11) The value in using bobbinet on the Padgett dermatome is that tension is made on the fabric and not on the skin when the graft is removed from the dermatome. “Backed” grafts (bobbinet or vaseline gauze) eliminate considerable suturing. Fabrics made of fine thread woven in a hexagonal pattern allow stretch in all directions. When this is rubberized, a transparent membrane is formed, suturing through it is made easy by dabbing mineral oil or vaseline over the areas which will be pierced with a needle. Cotton fabric is preferred for reasons described in a previous article but nylon and rayon fabrics are satisfactory. Any of the fabrics may be sterilized by soaking in ether in the operating room. They dry immediately after being removed from the container.