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Hand Knife Versus Powered Dermatome: Current Opinions, Practices, and Evidence

Tehrani, Hamid MBBS, MRCSEd; Lindford, Andrew MBBS, MRCSEd; Logan, Andrew M. FRCS

doi: 10.1097/01.sap.0000214902.79193.4e
Original Article

Some surgeons prefer to use powered dermatomes when harvesting split-thickness skin grafts, while others prefer the hand knife. We conducted a postal survey of British plastic surgery units, contacted medicolegal departments, and investigated the literature to explore the reasoning for any preferences and the existing evidence to support such practices.

Two hundred thirty-eight surgeons from 30 units replied, 145 (61%) preferring to use the powered dermatome, primarily as they believed it provided for better-quality graft and donor sites. Ninety-five (40%) respondents felt they were potentially open to successful litigation by using a hand knife when a powered dermatome was available.

We found no evidence to support such clinical or medicolegal views and conclude that numerous misconceptions exist about skin-graft harvesting instruments. We suggest that surgeons should use whichever instrument they feel will, in their hands, provide the optimum result and not be directed by unfounded opinions.

A survey of 233 British plastic surgeons disclosed that 61% preferred to use powered rather than hand dermatomes, with 40% reporting concerns that use of the hand dermatome might subject them to legal exposure.

From the Norfolk and Norwich University Hospital, Norwich, England.

Received January 9, 2006, and accepted for publication January 24, 2006.

Attributed to: Department of Plastic and Reconstructive Surgery Norfolk and Norwich University Hospital Norwich, NR4 7UY England.

Reprints: Hamid Tehrani, Department of Plastic and Reconstructive Surgery, Royal Preston Hospital, Preston, Lancashire, NR4 7UY England. E-mail: contact@hamidtehrani.com.

© 2006 Lippincott Williams & Wilkins, Inc.