Full thickness skin graft from supraclavicular area
This is Richard Allen at the University of Iowa. This video demonstrates harvesting of a supraclavicular full thickness skin graft. This patient had a lower lid defect at mohs excision of a basal cell carcinoma. A lateral rotational flap was performed earlier in the surgery which proved to be inadequate in covering the defect. Frost sutures are placed with 4-0 silk suture. A template of the defect is made with telfa and transferred to the supraclavicular area. The supraclavicular area is a useful site for harvesting full-thickness skin grafts in that it also contains non-hair bairing skin and the scar is easy to hide. A 15 blade is used to make an incision through the skin and then the graft is harvested with Westcott or Stevens scissors. The harvest is performed to excise as little subcutaneous fat as possible so that only dermis and epidermis remains. The area is then widely undermined with monopolar cautery. Closure is performed with deep interrupted 4-0 Vicryl sutures. This should be placed in a buried fashion with the knot deep. The skin is then closed with 5-0 prolene suture which is placed in an interrupted vertical matress fashion. These could also be placed in a running suture, but the vertical matress better everts the skin edges. The graft is placed followed by a bolster. The frost sutures are taped to the forehead and the eye is patched and remains patched for one week. The patient returns in one week for removal of the patch, bolster, and sutures.