Split thickness skin graft (STSG)

Considerations

Preparation

• • dermatome

  • mineral oil

  • tongue blade

  • 1:1000 epinephrine in cup

  • Telfa

  • dressing materials for harvest site (depends on attending, see below)

  • dressing materials for recipient site (depends on location of recipient site, i.e. scalp, leg, forearm, see below)

  • ruler

  • marking pen

Procedure

• • Steps

    • • 1. Measure defect size with ruler.

        2. Mark the rectangular dimensions of the STSG to be harvested from the anterior thigh.

           • Dimensions must be larger than the measured defect size for two reasons. 

           • First, it must lay flat on the recipient wound bed which is not even and has irregularities to it. 

           • Second, it has to account for the differences in height of the recipient wound bed relative to the surrounding skin edges.

        3. Select the correct dermatome blade width and thickness.

           • Width of the blade comes in intervals of whole-number inches.  To get a different width, the blade has to be switched out. 

           • Make sure not to get centimeters and inches confused, as can happen if measuring the defect size in centimeters and not recognizing that the blade width is in inches.

           • Thickness is set by a dial on the dermatome (0-30), with 30 being the thickest.  The setting is almost always 16 or 18.  

        4. Apply mineral oil liberally to the harvest site.

        5. Harvest the STSG.

• • • • • Have your assistant use a tongue blade to flatten out the skin ahead of the dermatome path so that the full width is harvested

        • Activate the dermatome prior to engaging the skin by activating the handle.

        • Place the dermatome at a 45 degree angle to the thigh.

        • Applying even and steady pressure, harvest the STSG in a forward, ergonomic motion. 

• • • • 1. Pull the STSG from the dermatome with pickups and place on a Telfa pad.

        2. Apply epinephrine-soaked Telfa to the harvest site for hemostasis.

        3. Inset the STSG into the recipient site.

           1. Tack down one side with a running 5-0 FAG suture.

           2. This side should not overhang the wound edge; this allows for sufficient graft to lay flush on the wound bed and for sufficient length to reach the other sides.

           3. Tack down the other sides of the defect with a running 5-0 FAG suture.

           4. Trim the excess graft off the sides with scissors.

        4. Pie-crust the STSG with a 15 blade.

        5. Place tacking sutures into some, but not all, of these pie crusts with interrupted 5-0 FAG.

• Dressings

  • Apply bolster dressing to the recipient site.

    • For leg, place Mepitel, Xeroform, and wound vac sponge, in that order.  The wound vac sponge should overhang the site so that it can be stapled down.

    • For forearm, apply the same materials as leg, but often Xeroform log rolls are placed in between the tendons as well.  

    • For scalp, a ball of Xeroform is placed onto the STSG and secured with interrupted Silk sutures that circumferentially span the recipient site and tie down onto the Xeroform ball.

  • Apply dressing to the harvest site.

    • Dr. Gurushanthaiah: apply Mastisol to the skin around the harvest site and then place a large piece of Tegaderm.

    • Dr. Wang: apply flat piece of Xeroform to the site and secure with interrupted Silk sutures or staples.

Post-op

High-Yield

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