Overlapping of split-thickness skin grafts to prevent junctional hypertrophy

Abstract

Sir, Splitor partial-thickness skin grafting is one of the oldest procedures performed in plastic surgery [1] and is the most commonly used procedure for reconstructing defects of various sizes and anatomical locations [2]. When defects are large, it is frequently not possible to provide wound coverage with one split-thickness skin graft alone due to limitations in the width of the graft that can be harvested with an electric dermatome or hand-held knife. In these circumstances, it may be necessary to use two or more separate sheets of skin graft in order to resurface the wound. When this is necessary, the technique most commonly employed is to place the two skin grafts side-by-side on the wound so that their edges are apposed, and these grafts are then sutured, stapled or glued together. We have observed that this technique can cause hypertrophy and ridging or delayed wound healing at the junction between the two grafts, as can be seen in Fig. 1. However, we have found that this junctional ridging can be avoided by laying down the two grafts side-by-side with an overlap of 3–5 mm and leaving the junction between the two grafts unsecured. This is demonstrated in Fig. 2 (left panel). The two grafts are secured to the wound edges with fast-absorbing sutures. The excess overlapped skin at the junction between the grafts eventually sloughs off (much like the excess graft along the margins of the wound), and when the graft takes, there is little or no evidence that there were ever two separate grafts on the wound bed, and junctional ridging is thus avoided. This is demonstrated in Fig. 2 (right panel), which is the same patient 4 months postoperatively. To our knowledge, this technique has hitherto not been reported in the literature. We have employed this technique in over fifty patients with large skin defects resulting from