Skin Graft Harvest Research Articles

Advancements in Skin Grafting: Development and Applications of a Novel Two-Blade Dermatome for Concurrent Split-Thickness and Dermal Graft Harvesting A technical note and proof of principle

This investigation delineates the evolution and prospective utilisations of an innovative two-blade dermatome, designed for the concurrent harvesting of a conventional split-thickness skin graft (STSG) and 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 and demonstrative of a proof of principle application, offers a technical 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: Firstly, employing solely the dermal component for grafting and repositioning the uppermost skin flap to the donor site markedly diminishes donor site morbidity. Secondly, owing to its elasticity, the dermal graft reduces the need for meshing, thereby enhancing cosmetic outcomes. Thirdly, utilising both the uppermost skin layer and deeper dermal layer for the recipient site can reduce donor site areas. Fourthly, 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 possibly obviating the subsequent STSG, as 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 the 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, where dermal grafts may prove beneficial.

A Study of Cadaveric Skin Graft Harvest and Usage: An Observational Prospective Pilot Study.

Background Burn injuries pose a significant global public health challenge, causing substantial morbidity and mortality, particularly in low- and middle-income countries. Timely and effective wound coverage is critical in treating severe burns to prevent infection, reduce pain, and promote healing. Cadaveric skin grafts (allografts) have become essential in treating extensive burn wounds, serving as temporary biological dressings to prepare the wound bed for autografting. This study aims to comprehensively analyze the process of cadaveric skin graft harvest and usage in a tertiary care setting. It seeks to evaluate the procedures, challenges, and outcomes associated with cadaveric skin grafts, contributing to optimizing burn care practices and improving patient outcomes. Methods This observational study was conducted at a tertiary care hospital and burns center with a skin bank, involving 44 cadaveric skin graft harvests and 27 applications between July 1, 2011, and June 30, 2013. The study focused on prospective donors and recipients needing cadaveric skin grafts. Inclusion criteria for donors included consent from the next of kin and the absence of infections or septicemia, while exclusion criteria included prolonged post-mortem intervals and medico-legal cases. The procedures adhered to the Euro Skin Bank protocols, encompassing retrieval, processing, storage, and usage. Data were analyzed using Epi-Info version 7.2.1 software, employing descriptive statistics for categorical variables. Ethical clearance was obtained from the university ethical committee, with mandatory written informed consent for skin donation. Results Out of 519 deaths in the tertiary care hospital, significant barriers to skin donation included septicemia, skin changes, late reporting, young age, medico-legal issues, and positive viral markers. Notably, 114 (21.97%) of next of kin refused consent. Cadaveric skin was harvested in five (11.36%) cases, with potential donors identified in 78 (15.02%) of deaths. Donors were predominantly older males, with efficient procurement processes ensuring timely harvests. The tertiary burns center facilitated 39 (88.63%) cases of cadaveric skin harvests with a skin bank, either at the donor's home or other hospitals notified to the burns center. Cadaveric skin grafts were applied in 27 cases, primarily for burns, with high graft uptake observed over 10 days. Non-healing ulcers showed 100% graft uptake. The survival rate among burn patients was 20 (74%), with deaths mainly due to sepsis and multi-organ failure. Significant barriers to obtaining consent included a lack of awareness, superstitions, social stigmas, and religious objections. Conclusion The study highlights the critical role of cadaveric skin in managing extensive wounds, particularly burns. Despite challenges in obtaining consent and limited donor availability, cadaveric skin grafts effectively prepared wound beds for autografting, contributing to improved patient outcomes. Increasing community awareness and addressing superstitions and social stigmas are essential for improving donation rates.

Staged Periorbital Reconstruction for Cicatricial Lagophthalmos

Introduction: Eyelid trauma can present reconstructive challenges for facial surgeons. The authors postulated that treating cicatricial lagophthalmos with protective ptosis in the acute setting prior to definitive grafting could help limit scar contraction. Material and Methods: This is an observation of a patient who benefited from a staged approach to periorbital reconstruction after suffering extensive facial trauma. Informed consent was appropriately obtained from the patient. Results: After treating the periorbital injury in staged fashion, an aesthetically acceptable result was achieved and was well-tolerated by the patient. Discussion: Disruption of the periorbital region, particularly the eyelids, can have severe functional and aesthetic consequences. One such disruption is lagophthalmos. Neurotoxin-induced protective ptosis is a well-known strategy that can be used as the initial treatment in a staged approach to cicatricial lagophthalmos. Conclusion: Treating lagophthalmos with protective ptosis in the acute setting prior to definitive grafting is not only a means of avoiding tarsorrhaphy but also it can allow time for the wound to declare itself and limit scar contraction. In addition, the contralateral eyelid represents both a complimentary skin graft harvest site as well as an opportunity to create a symmetrical repair.

Implementation of a Hand Training Curriculum in Junior Resident Education: Experience at a Military Orthopedic Residency Program

The American Society for Surgery of the Hand developed the Surgery Training and Educational Platform (STEP) in order to assess essential skills in hand surgery. The American Society for Surgery of the Hand designed modules spanning both osseous and soft tissue skills aimed to be cost effective for the purpose of orthopedic surgical education. The STEP curriculum was adapted and implemented at a single military orthopedic residency program. The following six modules were implemented: (1) depth of plunge, (2) scaphoid pinning, (3) phalangeal fracture pinning, (4) microsurgery, (5) full-thickness skin graft harvest, and (6) wrist arthroscopy. Both first- (PGY1) and second-year (PGY2) residents participated. Scores were calculated according to the original STEP curriculum criteria and were compared with historic data from the previous year. All residents responded to an evaluation questionnaire following the performance of the tasks. The PGY2 cohort outperformed PGY1 cohorts across all modules except for the depth of plunge and scaphoid fixation modules. In the phalangeal pinning module, PGY2s did significantly better when compared with pooled PGY1 performance and their own PGY1 performance (P < .05). In the microsurgery module, PGY2s scored better than pooled PGY1s. In the full-thickness skin grafting module, PGY2s outperformed PGY1s (P < .05). On the post-task evaluation, residents unanimously responded that this was a valuable exercise, but the time required to complete all the modules was significant, similar to that of the previous year survey. The STEP simulation is a cost effective and reliable program to engage residents in hand surgery-related skills. However, adaptations should be encouraged according to institutional resources to provide the most inclusive training platform possible per institutional constraints. The STEP simulation is interpreted by residents as a valuable exercise but requires a significant time commitment that could be a barrier to implementation and regular use. Therapeutic IV.

762 A Systematic Review of Surgical Simulation in Burn Surgery: Education, Assessment, and Management

Abstract Introduction Proper assessment and management of burn patients requires practical knowledge and timely interventions in a high-stakes setting. Although much of burn care emphasizes critical care, nuances exist among this patient population, creating challenges for surgeons-in-training. As a result, low- and high-fidelity burn simulations have become increasingly popular means to educate burn care physicians and their teams in a safe environment without compromising care or endangering patients. The aim of this report is to systematically review the literature for existing simulations related to burn care. Methods A systematic review was conducted using the following databases: PubMed, Scopus, Embase, Web of Science, and Cochrane. Inclusion criteria were peer-reviewed articles about surgical simulation models related to burn care and surgery. Skills and techniques taught, assessment methods, model type, fidelity, and equipment were extracted from included studies. Conference proceedings, reviews, non-English and non-burn-specific literature were excluded. Results Our search criteria identified 2,585 articles, 16 of which met inclusion criteria. Simulation methods included 7 simulation courses (43.8%), 6 synthetic benchtop models (37.5%), 2 augmented/virtual reality interfaces (12.5%), and 2 iOS applications (12.5%). There were no burn-specific animal or cadaveric models. Model fidelities included 9 (56.3%) high-, 3 (18.8%) medium-, and 4 (25.0%) low-fidelity. The most common topics included in the simulations were burn wound assessment/management (n=10, 62.5%), escharotomy (n=6, 37.5%), fluid management (n=2, 12.5%), electrical burns (n=1, 6.2%), skin graft harvest (n=1, 6.2%), tangential excision (n=1, 6.2%), and cricothyrotomy (n=1, 6.2%). Conclusions Burn management requires an expansive breadth of intensive care knowledge and surgical expertise combined with a distinct, burn-specific skill set. A paucity exists in the literature for augmented/virtual reality and animal/cadaver models unique to burn care and surgery. Our review identified a need to expand simulator options to improve training in skin grafting, burn reconstruction, and burns-specific intensive care management. Applicability of Research to Practice Given the rapidly expanding emphasis on remote learning in the post-COVID era, developing accessible surgical simulation infrastructure adjacent to clinical training may better prepare global burn providers for the complexity of burn care.

Old dog, new tricks: split-thickness skin graft harvesting from the postauricular scalp using a Silver manual dermatome.

Abstract Click here for the corresponding questions to this CME article.

Adipose trimming and reducing risk of graft falling on the floor

Traditionally, full thickness skin grafts are defatted after excision in the surgeon's palm or on the surgeon's finger. This increases the risk of dropping the graft on the floor. Though convenient methods of full thickness skin graft harvesting have been previously demonstrated, we propose a technique to reduce the risk of dropping grafts on the floor during preparation that does not require any additional surgical instruments.

Training outside of the operating room improves intern resident psychomotor skills on a validated ASSH tool

• Given work restrictions, orthopaedic training is increasingly dependant on surgical simulation. • STEP modules is a low cost simulation for psychomotor skills in hand surgery. • STEP training with limited supervision improved performance in certain modules. • The STEP simulator may be valuable for resident education and assessment. The Surgical Training and Educational Platform (STEP) was developed by the American Society for Surgery of the Hand (ASSH) as a cost-effective set of surgical simulation modules designed to represent critical psychomotor skills in hand surgery. We hypothesize that increased training on these training modules, even with limited supervision, would improve resident performance on psychomotor skills. Baseline evaluation was conducted on four psychomotor skills to simulate surgical tasks: lag screw fixation, depth of plunge, skin graft harvest, and wrist arthroscopy. One-third of them received limited supervised training for one month and two-thirds did not (control). After the training period both groups were re-evaluated and their performance was analysed. Six ACGME accredited orthopaedic surgery residency programs. All 26 residents in the intern bootcamp participated and completed the study. Selection to the Trained Group was based on willingness and ability to participate. Others remained in the Control Croup. Compared to baseline, the Control Group performed worse in depth of plunge while showing no improvement in other tasks in the final assessment. Compared to baseline, the Trained Group improved in lag screw fixation and in total score after training, with the greatest improvement in the half with the lowest pre-training scores. Post-training, the Trained Group outperformed the Control Group in depth of plunge. Training outside the operating room even with limited supervision improved psychomotor skills in orthopaedic surgery interns as assessed by the STEP modules. The STEP simulator is a validated instrument and may be valuable for resident education and assessment.

Outcomes on the Utilization of Lipodermoid Skin for Anterior Lamella Reconstruction in Severe Lipodermoids With Eyelid Coloboma: A Case Series.

Two young children with upper lid colobomas and associated lipodermoids underwent eyelid reconstruction using lipodermoid skin as an autograft with good cosmesis. We describe their presentation, surgical management, and clinical progress following reconstruction, demonstrating the suitability of this skin as an adequate graft avoiding the need for further skin graft harvesting in such cases.

Gluteal Fold V-Y Advancement Flap for Genital Reconstruction following Radical Vulvectomy with Bilateral Inguinofemoral Lymphadenectomy in Vulvar Cancer: A Case Report

Background: Vulvar cancer is a rare malignancy representing about 4% of all genital cancers in women. Historically, the gold standard for treatment of squamous cell carcinoma of the vulva was en bloc radical vulvectomy with bilateral inguinofemoral lymphadenectomy. For the reconstruction the options are primary closure, skin grafts, or local and distant flaps. In this case we used the gluteal fold fasciocutaneous V-Y advancement flap that is sensate and thin with a reliable blood supply, can be advanced easily, and can be performed in a single-stage procedure. Care Report: We present a clinical case of an 82- year old female patient who had an exophytic vulvar lesion, which grew progressively with the histopathologic diagnosis of invasive vulvar squamous cell carcinoma. It was decided to perform radical vulvectomy with right unilateral lymphadenectomy and reconstruction with Gluteal Fold V-Y Advancement Flap. During the post-surgical period it recurred with wound dehiscence and finally skin necrosis developed in the area of the left thigh. Surgical debridement, escharectomy, harvesting and application of skin graft, and closure of the femoral hernia with omentum patch were performed with no associated complications. Follow-up was carried out during the next 3 months after surgery. She presented adequate evolution of the flap and left thigh area. Conclusions: The Gluteal Fold V-Y Advancement Flap is an excellent option for the reconstruction of the vulvovaginoperineal area after a radical vulvectomy. It provides us with a good prognosis and quality of life for the patient. Article Details Issue

Comparison of blood loss at the donor site &amp; Acute cardiovascular effects by using adrenaline infiltration and topical adrenaline during skin graft harvest

Background. Burn surgery is associated with high blood loss to both the donor and recipient site. Although various techniques for reducing intraoperative blood loss have been described, topical adrenaline and adrenaline infiltration have significantly reduced blood loss. The present study compared blood loss to the donor site and acute cardiovascular effects (such as heart rate/ HR and blood pressure/ BP), by using adrenaline infiltration and topical adrenaline while harvesting the skin graft in the same patient, but in a different place. Materials and Methods. It is a prospective study that included 50 patients, all undergoing skin graft harvesting using method 1 and local adrenaline - method 2, in different locations. Blood loss and acute cardiovascular effects were assessed and compared between two methods. Results. Blood loss at the donor site is significantly lower in adrenaline infiltration compared to topical infiltration (4.7±0.6 ml vs 10.4±1.2 ml, p&lt;0.001). Compared to baseline, the mean increase in HR and BP was significantly higher after adrenaline infiltration than topical adrenaline, but for a short period of time. Changes in HR values were larger than in BP. Conclusions. Our study showed that adrenaline infiltration was better than topical adrenaline in conserving blood loss, but acute cardiovascular effects (increased BP and HR) were greater after infiltration, being clinically insignificant and requiring no treatment.

Clinical effects of free latissimus dorsi myocutaneous flap combined with artificial dermis and split-thickness skin graft in the treatment of degloving injury in lower extremity

Objective: To observe the clinical effects of free latissimus dorsi myocutaneous flap combined with artificial dermis and split-thickness skin graft in the treatment of degloving injury in lower limbs. Methods: A retrospective observational study was conducted. From December 2017 to December 2020, 8 patients with large skin and soft tissue defect caused by degloving injury in lower extremity were admitted to Ningbo No.6 Hospital, including 5 males and 3 females, aged from 39 to 75 years, with wound area of 25 cm×12 cm-61 cm×34 cm. The free latissimus dorsi myocutaneous flap with latissimus dorsi muscle in the width of 12-15 cm and flap area of 20 cm×8 cm-32 cm×8 cm was used to repair the skin and soft tissue defect of bone/tendon exposure site or functional area. The other defect was repaired with bilayer artificial dermis, and the flap donor site was sutured directly. After the artificial dermis was completely vascularized, the split-thickness skin graft from thigh was excised and extended at a ratio of 1∶2 to 1∶4 and then transplanted to repair the residual wound, and the donor site of skin graft was treated by dressing change. The survival of latissimus dorsi myocutaneous flap, artificial dermis, and split-thickness skin graft after operation was observed, the interval time between artificial dermis transplantation and split-thickness skin graft transplantation was recorded, and the healing of donor site was observed. The appearance and function of operative area were followed up. At the last outpatient follow-up, the sensory recovery of flap was evaluated by British Medical Research Council evaluation criteria, the flap function was evaluated by the comprehensive evaluation standard of flap in Operative Hand Surgery, the scar of lower limb skin graft area and thigh skin donor area was evaluated by Vancouver scar scale, and the patient's satisfaction with the curative effects was asked. Results: The latissimus dorsi myocutaneous flap survived in 6 patients, while the distal tip of latissimus dorsi myocutaneous flap was partially necrotic in 2 patient and was repaired by skin grafting after resection at split-thickness skin grafting. The artificial dermis survived in all 8 patients after transplantation. The split-thickness skin graft survived in 7 patients, while partial necrosis of the split-thickness skin graft occurred in one patient and was repaired by skin grafting again. The interval time between artificial dermis transplantation and split-thickness skin graft transplantation was 15-26 (20±5) d. The donor site of latissimus dorsi myocutaneous flap healed with linear scar after operation, and the thigh skin graft donor site healed with scar after operation. The patients were followed up for 6-18 (12.5±2.3) months. The color and elasticity of the flap were similar to those of the surrounding skin tissue, and the lower limb joint activity returned to normal. There was no increase in linear scar at the back donor site or obvious hypertrophic scar at the thigh donor site. At the last outpatient follow-up, the sensation of the flap recovered to grade S2 or S3; 3 cases were excellent, 4 cases were good, and 1 case was fair in flap function; the Vancouver scar scale score of lower limb skin graft area was 4-7 (5.2±0.9), and the Vancouver scar scale score of thigh skin donor area was 1-5 (3.4±0.8). The patients were fairly satisfied with the curative effects. Conclusions: In repairing the large skin and soft tissue defect from degloving injury in lower extremity, to cover the exposed bone/tendon or functional area with latissimus dorsi myocutaneous flap and the residual wound with artificial dermis and extended split-thickness skin graft is accompanied by harvest of small autologous flap and skin graft, good recovery effect of functional area after surgery, and good quality of healing in skin grafted area.

Skin Graft Donor Site Healing among Elderly Patients with Dermatoporosis - A Case Series.

We reviewed donor site wound healing among morbid ≥65-year-old patients after split-thickness skin graft (STSG) harvesting. Patients were treated for a pretibial laceration or hematoma in Kymenlaakso Central Hospital, Finland, between 2015 and 2019. Twelve morbid patients with a mean Charlson Comorbidity Index of 7.1 (range 4-12) and a mean age of 80.6 years (range 69-91) were studied. Nine patients were female. Eight had a chronic cutaneous fragility syndrome, eg, dermatoporosis. All donor site areas were located on the thigh and were less than 2% TBSA. One donor site infection occurred. STSG integration on the pretibial wound bed was successful with all patients, and none of the patients needed further operative treatment. Graft thickness varied between 0.010 to 0.014 inches. STSG donor sites healed within the normal range of 21 days in 50% of patients. Among two patients, healing took 25 days, and among four, 37 to 97 days. All donor sites healed via local wound care without the need for regrafting. 4Our study indicates that harvesting STSG from elderly and morbid patients with poor skin condition is safe and does not result in significant complications. Prolonged donor site healing can occur, which can be managed with regular local wound care.

A Systematic Approach to Incision Planning and Graft Excision in Gender-affirming Vaginoplasty.

Summary:We present our systematic approach to incision planning and skin graft excision for gender-affirming vaginoplasty. This approach is adaptable to patients of different body habitus and genital skin surface area, and it allows for early skin graft harvest with predictable wound tension at closure. We also describe how to adapt in cases of severe genital hypoplasia.

Collagen Dressing Versus Conventional Vaseline Gauze Dressing in Reducing Pain and Infection at the Donor Area for Skin Grafting: A Prospective Interventional Study

Introduction: The harvest of a split thickness skin graft causes a partial thickness injury and an outflow of blood and protein rich exudate from the donor site wound. Conventionally, closed dressings are employed using petroleum jelly impregnated gauge which are permeable to bacteria and wound exudate soaks through. This may lead to pain and infection of the donor site. Biological dressings create the most physiological interface between the wound surfaces and the environment and also dressings are natural, non immunogenic, non pyrogenic and hypo allergenic. Collagen sheet is one such dressing material used. Aim: To compare the conventional dressing using petroleum jelly impregnated gauze versus biological dressing with collagen sheets in terms of pain, infection and healing at skin graft site. Materials and Methods: It was a prospective interventional study conducted in Department of Surgery, SSG Hospital and Medical College, Baroda, Gujarat, India over a period of November 2012 to November 2017 on 220 participants. Randomisation was done by choosing an envelope containing cards marked ‘A’ or ‘B’. The group A (110) was a study group with collagen sheet dressing while group B (110) was the control group with conventional vaseline gauze dressing. Both group patients were examined at six hours postoperatively and then two times a day at 8:00 am and 8:00 pm daily. They were evaluated for pain with Visual Analogue Scale (VAS) score, infection, haematoma formation, healing at donor site and allergic reaction to collagen. Results: Mean VAS score for pain showed that it decreased over a period of time in both the groups. The group with collagen sheet dressing shows decreasing means VAS score from 4.34 on 1st day to 0.29 on 3rd day (p&lt;0.0001). Similarly, the vaseline gauze dressing shows decreasing mean VAS score from 5.64 on 1st day to 1.39 on 3rd day (p&lt;0.0001). Conclusion: Collagen sheet dressing are easy to apply, with advantage of less pain at donor site and lower infection rate. Also healing time required is less than the vaseline gauze dressing. collagen sheet dressing is clinically more efficient overall.

A STUDY OF EFFECTIVENESS OF MARKING OUT THE ANAESTHETISED AREA FOR HARVESTING SPLIT THICKNESS SKIN GRAFT UNDER LOCAL ANAESTHESIA

Management of wounds has always been and always will be one ofthe primary jobs of a surgeon. Split thicknessskin grafting [SSG]is one ofthe most common and simplest ways to manage a chronic or an acute wound. Harvesting of split thickness skin graft is a procedure, which produces considerable pain to the patient and requires anaesthesia. Harvesting of SSG under local anaesthesia has been described. Often the area that is anaesthetised is difcult to identify resulting in the skin graft blade trespassing into an un anaesthetised area causing pain to the patient. We present here a simple technique, which will help the surgeon identify the area anaesthetised thus avoiding pain. MATERIALSAND METHODS : The donor area for the split thinsskin graft was marked out using the technique of leaving behind the hypodermic needles and the effectiveness of the technique was assessed using a visual analog scale at the completion of the graft harvest. RESULTS:Fifteen patients underwentsplitthicknessskin graft underlocal anaesthesia during the study period.Eight patients had aVASscore of 0 and 5 patients has a score of 2 and two had a score of 3. No patient developed any complications as a result of the procedure. CONCLUSION:Thissimple techniqueofmarkingthe anaesthetisedarea is effective andsafe foruseduringtheharvestofsplitthicknessskingraft.

465 Split-thickness Skin Graft Harvest under Local Anaesthetic: A Single Pass Technique

Abstract Adequate local anaesthetic, in harvesting a split thickness skin graft (SSG), involves multiple passes of a needle across the length and width of the marked donor site. We describe a technique using hyaluronidase to uniformly anaesthetise an SSG donor site with one injection, in one pass of one needle. Mix 10mls 1% Lidocaine solution with Adrenaline 1:200,000 with 1 vial Hyaluronidase 1 Unit/ml solution. The mixture is buffered with 1 ml NaHCO3 to neutralise acidity and minimise pain.Mark out the SSG donor siteUsing a 27G long needle (sterican), enter perpendicular to the skin in the middle of the proximal aspect of the donor site. Inject some local anaesthetic subdermally, creating a mound.Change the angle of the needle to 180 degrees and continue to inject the remaining anaesthetic along one half of the width of the donor site.Using a rolled 4x4 swab, apply firm advancing pressure to distribute the mound across the remaining width and length of marked donor site.As the mound advances, the hyluronidase/anaesthetic mixture will distribute uniformly across the donor site within the same plane. The skin blanches secondary to the adrenaline during its distribution. The technique described is a fast, reproducible way to improve patient comfort through the elimination of repeated passes of a needle, distribute the anaesthetic uniformly across the donor site, and facilitate the acquisition of an SSG of uniform thickness The technique described is a fast, reproducible way to improve patient comfort through the elimination of repeated passes of a needle, distribute the anaesthetic uniformly across the donor site, and facilitate the acquisition of an SSG of uniform thickness

A prospective, comparative study of outcomes with Melolin, collagen sheet and traditional vaseline gauze dressing for healing of skin graft donor site in burns cases

Donor site following skin graft harvest have plenty of options available for dressing. We compared outcomes of Melolin, Collagen sheet and traditional Vaseline gauze for this purpose. Aim: The aim of the present study was to evaluate the outcomes Melolin, Collagen sheet and traditional Vaseline gauze for healing of skin graft donor site. Materials and Methods: Total 45 patients of Skin grafting procedure between August 2020 and July 2021 Burns unit affiliated to a tertiary care-teaching unit in Mumbai were taken in this research. Data was collected as VAS scores for pain evaluation, re-epithelialization time in days, infection rate and VSS score for scar quality for each dressing material. Mean Values of all parameters were calculated and compared. Results: Mean VAS score in Melolin group was 3.6, Collagen sheet group was 2.73 and Vaseline gauze group was 5.2. Re-epithelialization in Melolin group was achieved in 13.53 days (Mean), Collagen sheet group in 12.73 days (Mean) and Vaseline gauze group in 15.2 days (Mean). Mean Infection rate in Melolin group was 0.2143, Collagen sheet group was 0.0667 whereas Vaseline gauze showed 0.3333. Mean VSS score of 4.73 in Melolin group, 4.6 in Collagen sheet group and 5.2 in Vaseline gauze group. Mean VSS score of 4.73 in Melolin group, 4.6 in Collagen sheet group and 5.2 in Vaseline gauze group. Conclusion: Melolin, Collagen Sheet showed low pain scores, faster re-epithelialization, low infection rate and comparable VSS scores with regularly used Vaseline gauze.

History of Skin Graft Harvesting- A Mini Review

History of Skin Graft Harvesting- A Mini Review

Use of a topical mix of lidocaine and prilocaine during split-thickness skin graft harvest improves postoperative recovery—A prospective randomized controlled trial

PurposeTo provide evidence of efficacy and postoperative benefit of topical anesthesia (TA) for harvesting split-thickness skin graft (STSG) in an Asian population. Materials and methodsPatients with well-granulating wounds with skin grafting were randomized into TA or general anesthesia (GA) groups. In the TA group, an eutectic mixture of lidocaine and prilocaine (EMLA) was applied. Perioperative heart rate, postoperative donor site pain, adverse effects, patients’ satisfaction, duration of surgery, and operation room (OR) stay duration were recorded. ResultsThirty-nine patients (19 males, 20 females; mean age 54.9 ± 17.8) were included. Twenty underwent TA and 19 underwent GA for STSG. The TA group patients had tolerable pain during skin graft harvesting (VAS, 0.85 ± 1.5). Average EMLA exposure duration was 180.3 ± 65.8 min, and the amount applied was 1.72 ± 0.43 g/10 cm2. The TA group had lower donor site pain score at one hour postoperatively (1.34 ± 1.49 vs 3.08 ± 1.90, p = 0.005), lower OR stay duration (36.5 ± 6.5 min vs 65.1 ± 17.2 min, p < 0.001) and less adverse effects than the GA group. ConclusionHarvesting STSG under TA with EMLA is an effective and efficient approach for most Asian patients with less early postoperative donor site pain and fewer adverse effects.