Skin grafting on the lower leg as an out-patient ambulatory procedure

Abstract

Skin mobility on the lower leg is relatively poor. Excisional procedures often produce defects that are difficult or impossible to close by primary suture. Suturing under excessive tension predisposes to infection and frequently leads to wound dehiscence. The placement of skin grafts on the lower leg is usually considered to require post-operative immobilization in bed for several days. In the present series, split skin grafts were successfully used to repair 13 lower leg wounds of up to 4.5 cm in diameter in 12 patients aged 53–84 years (mean 67). All were treated under local anaesthesia as out-patients and all returned home immediately and remained ambulatory post-operatively. The lesions excised included squamous carcinoma, basal cell carcinoma and Bowen's disease. Haemostasis of the recipient site was achieved with diathermy. Donor skin from the ipsilateral thigh was sutured around the circumference with 4/0 monofilament polyamide overlapping the wound edges by 1–2 mm. After covering with paraffin gauze the graft was further immobilized with a tie-over sponge dressing. A stockinette tube was placed over the lower leg and foot and a firm crepe bandage applied which was fixed to the skin with tape. The donor site was covered with Opsite. Sutures were removed on the eighth post-operative day and the Opsite was removed from the donor site after 3–4 weeks. All grafts showed at least an 80% take and in most this was virtually complete. A seroma requiring aspiration developed beneath one graft and in another a minor staphylococcal infection developed. Skin grafting on the lower leg is feasible as an out-patient procedure. This is more convenient for the patient and greatly reduces the cost to the Health Service compared with conventional hospital treatment.