Repair of large skin defects with equal-sized composite donor grafts created by tangential joining of two semicircular skin grafts

Abstract

Objective To develop a new method to gain large-sized full-thickness skin grafts, which allows the direct closure of donor defects by shortening the width of donor area and reducing suture tension. Methods According to mathematical principles, a method was developed to design two semicircular skin grafts which were tangentially joined to form a skin graft whose size was approximately equal to that of a large skin defect. This method was applied to treat 9 patients with cutaneous malignancy, including 3 cases of squamous cell carcinoma and 6 cases of malignant melanoma. Lesions were located on the head or face in 3 patients and in the foot region in 6 patients. The size of lesions varied from 1 cm × 2 cm to 6 cm × 9 cm, and the size of defects after resection of lesions varied from 5 cm × 6 cm to 8 cm × 9.5 cm. Results The width of donor areas was decreased by using this method, and donor defects were directly closed with the avoidance of waste of donor skin. Two out of three patients with carcinoma on the head or face achieved complete survival of skin grafts, and one experienced mild erosion at the margin of skin grafts. Skin graft necrosis(10%-20%)was observed in foot soles of 6 patients, which healed 1-2 months after dressing changes. Conclusion Equal-sized donor grafts formed by tangential joining of two semicircular skin grafts are a good choice for the repair of relatively large skin defects. Key words: Skin neoplasms; Surgical procedures, operative; Skin transplantation; Methods