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A Simple and Reliable Technique for Harvesting Skin from a “Spare Part” by a Single Operator

Brooks, Darrell, M.D.; Kim, Sendia, M.D.; Buntic, Rudolf F., M.D.

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 460e-461e
doi: 10.1097/PRS.0b013e3181bcf253
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Buncke Clinic, Department of Microsurgical Transplantation and Replantation, Davis Campus, California Pacific Medical Center, San Francisco, Calif. (Brooks, Kim, Buntic)

Correspondence to Dr. Brooks, 45 Castro Street, Suite 121, San Francisco, Calif. 94114, dbrooks@microsurgeon.org

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Sir:

The harvest and application of a split-thickness skin graft is one of the most frequently performed procedures in reconstructive surgery. Regardless of the donor site, the principles for successful harvest are the same: adequate tension on the donor skin, an even donor surface, and a slippery donor surface.1 When these criteria are not met, reliable harvest usually requires more than one operator.

Surgeons have described techniques for harvesting split-thickness skin grafts in situations where they are operating alone or with an inexperienced assistant. Aslam used traction sutures placed in four quadrants to stabilize and restore surface tension when taking skin grafts from elderly patients with loose, unstable thigh skin.2 Zeligowski and Ziv advocated suturing tissue that had been avulsed back to its original site under adequate tension to allow standard dermatome harvest.3 Goris and Nicolai used two assistants to stretch the avulsed tissue over gauze or over the patient's uninjured thigh to restore conditions for successful harvest.4

We previously described miniabdominoplasty during rectus abdominis muscle harvest for extremity reconstruction.5 The dermolipectomy specimen was treated as a “spare part” for skin graft harvest. The purpose of this report is to describe our simple and reliable technique for harvesting split-thickness skin from a spare part by a single operator.

The tissue is placed over rolled operating room towels and secured with towel clamps, such that peripheral traction is applied re-establishing skin tension and a uniform surface. The clamps are placed in the dermal layer to keep their edges clear of the dermatome guide, guaranteeing unobstructed harvest (Fig. 1). After mineral oil is applied, a single operator can grasp the towel clamp at the apex of the bolstered tissue and apply stable traction against the advancing dermatome. Alternatively, a Weck blade may be used for smaller tissue harvest. Figure 2 demonstrates the harvested skin graft with the spare part.

Fig. 1.

Fig. 1.

Fig. 2.

Fig. 2.

Over a 2-year period, 25 patients underwent a combined procedure of rectus abdominis muscle harvest with a miniabdominoplasty. In these patients, the dermolipectomy tissue was used as a spare part for split-thickness skin grafting. A single operator harvested the skin graft with a Paget dermatome or Weck blade using the described technique. The average quantity of tissue harvested was 150 cm2 (range, 100 to 250 cm2). Twenty-three of 25 patients (92 percent) did not require additional grafting. The remaining two patients required less than 50 cm2 of additional split-thickness skin graft.

The benefits of this technique are multiple. For the surgeon, the technique is simple to perform and the result is reliable. It requires no specialized equipment other than what would be used in standard skin graft harvest. A single operator without skilled assistance can accomplish it. The patient is spared the morbidity of a skin graft donor site entirely, or benefits from a smaller donor site. A thicker, more durable skin graft may be harvested from the spare part without further consequence to the patient. In addition, the patient receives the welcome dividend of an improved abdominal contour.

Darrell Brooks, M.D.

Sendia Kim, M.D.

Rudolf F. Buntic, M.D.

Buncke Clinic

Department of Microsurgical Transplantation and Replantation

Davis Campus

California Pacific Medical Center

San Francisco, Calif.

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REFERENCES

1.Ablove RH, Howell RM. The physiology and technique of skin grafting. Hand Clin. 1997;13:163–173.
2.Aslam A. A new method to facilitate skin graft harvest with minimal assistance. Ann Plast Surg. 1999;43:101–102.
3.Zeligowski AA, Ziv I. How to harvest skin graft from the avulsed flap in degloving injuries. Ann Plast Surg. 1987;19:89–90.
4.Goris RJ, Nicolai JP. A simple method of taking skin grafts from the avulsed flap in degloving injuries. Br J Plast Surg. 1982;35:58–59.
5.Brooks D, Buntic RF. An aesthetic perquisite of rectus muscle transplantation in extremity reconstruction. Ann Plast Surg. 2005;54:109–111.

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