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09.01.2015 admin
Science, Technology and Medicine open access publisher.Publish, read and share novel research. Useful Tips for Skin GraftsRei Ogawa1 and Hiko Hyakusoku1[1] Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan1. R Ogawa, S Aoki, M Aoki, K Oki, H Hyakusoku, Three-dimensional external skin graft fixation of digital skin graft. IntroductionSkin grafting is a common operative procedure that is widely used in plastic, reconstructive, and aesthetic surgery.
Beyond mere graft survival, however, the goals of surgery include good matching of texture and color and minimizing donor morbidity.
Skin-graft harvesting on the basis of a high-cut bathing suitWhen harvesting full-thickness skin grafts, it is important to consider each patient’s age and sex to select the appropriate donor sites [1].
The correct color and texture is of paramount importance, but also important is minimal donor-site morbidity. The favored donor sites usually include the postauricular and subclavicular regions, the medial side of the upper arm, and the inguinal region.
Of these sites, the inguinal region is often preferred because of its inconspicuous position and the facility of primary closure (Fig1a, b). However, a wound on the crease of inguinal region is much more objectionable than we had expected, especially for young female patients, because of the current vogue for swimsuits and short pants with high-cut leg openings. An example of such a case is that of a young woman in whom we selected the inguinal region as the donor site.
Moreover, the crease of the inguinal region is often pigmented because of chronic inflammation due to sweat or sebum.


It is, therefore, best to focus on the high-cut leg region rather than the inguinal crease (Fig1c, d). Another benefit of this approach is that the patient can be permitted to walk immediately after the operation, because when the legs are moved a wound in the high-cut leg region is subjected to less tension than is a wound in the inguinal region. Hemostasis is especially important in blood-rich regions such as the scalp, face, and hand. In such cases, drainage holes — which are also useful for the drainage of bacteria and exudates — should be made on the skin grafts. However, large drainage holes will leave scars; therefore, numerous small holes are preferred.
When using a flower holder for making drainage holes, split-thickness skin grafting is a good indication. However, such holes can cause scars, so this method is undesirable when skin grafting is performed in exposed areas such as the face and dorsum of the hand. Before developing the method described here, we had used to create holes using an 18-gauge injection needle. However, uniformly creating numerous small holes took considerable time with large skin grafts. Non-expanded mesh skin grafts are also an option for treating actively bleeding wounds, but they are of limited use for cosmetic purposes.4.
Use of a tie-over dressing with external wire-frame fixationWe have used external wire-frame fixation for skin grafts since 1986. In 1991, we reported this method and described two advantages: [1] the technique is useful for securing grafts to wound beds and [2] preventing the graft edges from lifting [2].


Moreover, we confirmed the usefulness of this technique for skin grafting to regions with free borders, such as the lips and eyelids [3]. Particularly for eyelid grafts, external wire-frame fixation overcomes the disadvantages of tarsorrhaphy [3].
Three-dimensional external wire frames are useful for fixing digital joints as well as skin grafts. If this method is used for digital skin grafts, the fixing of digital joints by pinning is not necessary, particularly for grafting the palmar surface of a finger.During surgery, the skin graft is fixed with sutures by the usual method.
At the same time, the wire frame, shaped like the graft itself, is made of 1.2-mm-diameter Kirschner wire. Next, the wire frame is attached with the same sutures already used for stitching the graft. The skin graft is then taken from corner to corner even if it involves application on a free edge. This method is helpful to secure the skin graft after operation, and the post operative course will be uneventful (Fig.3d). ConclusionsWe have presented three techniques that we have found to reduce complications and surgical invasiveness. However, most important is the surgeon’s determination to reduce complications and surgical invasiveness.




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