Split thickness skin graft
This is Richard Allen at the University of Iowa. This video demonstrates the harvesting of a split-thickness skin graft. In this case, the graft is used to cover an exenterated socket in a patient with a history of a sebaceous carcinoma. The dermatome blade is placed over the defect to determine the appropriate width to use. The anterior surface of the thigh is then anesthetized with 1% lidocaine with epinephrine. The area is then covered with mineral oil. The dermatome is then used to harvest the graft. Adequate pressure is placed on the thigh with the dermatome, and the motor is engaged and the dermatome is advanced. Forceps then are used to hold the split thickness graft and the dermatome is advanced further to acquire the graft. A number 15 blade is then used to cut the skin from the dermatome and the graft is transferred to the recipient site. The graft can be meshed to expand the graft if needed. In this case we did not mesh the graft. The donor site is then covered with epinephrine soaked gauze to stop bleeding. This is kept on the donor site as the graft is sutured to the recipient site.
The graft is then placed into the area of the recipient site and sutured into position with 5-0 fast absorbing sutures. Antibiotic ointment is then placed over the graft. Packing is then placed over the graft followed by an eye pad to place pressure on the graft to the recipient bed. The patch stays on for at least one week.
The leg is then dressed with Tedgaderm. This dressing should stay on for approximately 3 days.