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Technique
Technique
STSGs can be harvested with a no. 10 blade, Weck blade, or electric dermatome. The donor site is scrubbed with antiseptic and then anesthetized. The defect is measured, and a corresponding template is drawn on the donor site with surgical marking pen. If the STSG will be meshed with a meshing device to cover a very large defect, the graft can be undersized by 25% to 35%.7 If the STSG will not be meshed, the graft should be oversized by 10% to 20% to account for tissue contraction and ensure adequate wound coverage. Although STSGs contract to a greater extent than FTSGs, they can still be oversized to the same degree as FTSGs. STSGs may be uniformly fenestrated to allow for the outflow of blood and serous drainage, thus increasing their potential area of wound coverage and offsetting the extent of contraction observed compared to FTSGs.
If a freehand STSG is planned, a no. 10 blade is used to superficially score the area of skin to be excised while the skin is held taut. The blade is then placed nearly parallel to the skin, and starting at the scored edge the scalpel is used to create a surgical plane through the dermis while the graft is gently lifted from the wound edge with toothed forceps.
If the Weck blade, a razor-like knife, is used, the skin is held taut, and a sawing motion is employed with the blade placed almost parallel to the skin with forward and downward pressure applied, similar to a shave biopsy. If an electric dermatome is used, desired graft thickness is first adjusted on the dermatome. The operating surgeon then applies downward and forward pressure with the advancing dermatome while the skin is held taut and the skin graft is delivered from the dermatome with toothed forceps. Mineral oil can be applied to the surface of the skin to minimize friction and improve
the dermatome bladeโs ability to glide smoothly and uniformly across the skin surface.
If a meshing device is used, the desired expansion grid is selected and inserted into the device. The graft is then placed flat into the meshing device and advanced through with a lever. The harvested graft is transferred to a basin containing sterile saline. After careful hemostasis is achieved at the recipient site, the STSG is placed on the wound, trimmed with iris scissors to fit the defect, and sutured into place in a similar manner as with FTSGs. STSGs are typically quite large, and although simple interrupted sutures can be placed around the entire periphery of the graft site, suturing efficiency can be optimized by first positioning a number of interrupted anchoring sutures evenly around the edge of the graft and then placing a running suture around the entire graft perimeter. If the STSG was not meshed, a no. 10 or no. 15 blade can be used to create uniform linear fenestrations within the STSG. This allows serosanguinous fluid from the wound bed to drain into the dressing rather than pool under the graft where it will interfere with the graftโs ability to contact the wound bed. The donor site should be dressed with a moist occlusive dressing consisting of petrolatum, an absorbent layer, and surgical tape. The pinpoint bleeding present at the donor site will abate with a pressure dressing alone, and additional hemostasis with aluminum chloride or electrocautery is usually not required.