Retroauricular skin graft harvest
This is Richard Allen at the University of Iowa. This video demonstrates harvesting of a full thickness skin graft from the retroauricular region. A template of the defect from the eyelid has been made with a clear drape. The template is then transferred to the retroauricular area and outlined with a marking pen. The area has been previously anesthetized with local anesthetic. The outline is then completed. A 15 blade is used to make an incision along the marking. The incision is made along the inferior marking first followed by the superior edge of the marking. The full thickness skin graft is then harvested with Westcott scissors. The plane of dissection is at the subcutaneous fat. Hemostasis can be obtained with the unipolar or bipolar cautery. The graft is then placed in saline soaked gauze. The donor site is then widely undermined with the unipolar cautery. The defect can then be closed with deep interrupted 4-0 vicryl sutures. The goal of these sutures is to reapproximate the skin edges without any tension. A running 5-0 prolene suture is then used to complete the skin closure. Antibiotic ointment is placed over the donor site three times per day and the patient will return in approximately one week for suture removal. Attention is then placed on the graft. Inspection of the graft is performed. For a full thickness skin graft, the dermis and epidermis are retained. The subcutaneous fat is excised with Westcott scissors. This is performed by placing the graft on the index finger and using the back of the blades of the scissors to excise the fat. The graft can then be placed into the eyelid defect and sutured into position.