Free laminar thin band graft--a surgical therapeutic variant in the treatment of leg ulcers

Enhancing Lower Extremity Defect Coverage: High Viability Ultra-Thin Split-Thickness Skin Grafts Obtained from the Scalp

BACKGROUND

Repairing lower extremity defects presents challenges due to the scarcity of available local tissue. Skin grafting is a widely employed technique for addressing non-healing ulcers, improving the quality of life of patients and minimizing discomfort. However, using traditional donor sites, such as the thigh, can hinder mobility and result in noticeable scarring and pigmentation changes.

OBJECTIVES

This study aims to assess the effectiveness of a novel approach utilizing autologous ultra-thin split-thickness skin grafts (STSGs) harvested from the scalp using a disposable, commercially available razor blade named DermaBlade.

METHODS

Fifteen patients (median age: 72 years, eight males and seven females) with diverse lower limb lesions, including carcinomas and ulcers of varying etiologies, were prospectively enrolled. Donor sites included the sideburn extending to the hairy temporal skin (nine cases) and hairy occipital skin (six cases). Ultra-thin skin strips (<0.2 mm thick) were obtained from the scalp through the use of the disposable flexible blade DermaBlade. The strips were positioned over the receptor area with no sutures in most cases and secured using dressings. A substantial majority of patients (90%) achieved successful graft take with no complications. Swift re-epithelialization occurred within a median of 12 days for the donor site and 24 days for the receptor site. No hair transfer or alopecic scars were noted.

CONCLUSIONS

In contrast to traditional grafting methods, DermaBlade-assisted scalp grafting yields highly viable STSGs that adhere to wound beds without the need for sutures. Notable advantages of this technique encompass rapid wound healing, minimal complications, and superior cosmetic outcomes. Furthermore, it avoids scarring and alopecia, making it a promising approach for addressing lower extremity defects.

Freehand technique to harvest partial-thickness skin to repair superficial facial defects

BACKGROUND

The freehand-scalpel technique to harvest skin for grafting is a forgotten surgical art. Modern facial surgeons prefer to use local skin flaps or Wolfe-type full grafts to repair facial defects.

OBJECTIVE

To determine the relative merits and cosmetic results of freehand skin grafts to cover facial defects following Mohs surgery.

METHODS

We used the freehand-scalpel technique to harvest skin from the periauricular region of the neck and cheek, and other sites. After a local anesthetic is injected the number 15 or 10 blade is used to harvest skin by sequential tangential incisions. The average dermal thickness was about 1.0 mm. To improve cosmetic appearance, the overall shape and thickness of the graft was contoured during harvesting to fit cosmetic unit or facial line.

RESULTS

For more than 5 years we have used the freehand technique to repair superficial facial defects of the nose, ear, scalp, temple, forehead, and other nonhead sites. A total of 65 freehand procedures were performed to repair facial defects. The distribution of the anatomic sites and sizes are presented. The size ranged from less than 1 cm to greater than 5 cm in diameter. Three typical cases are presented to illustrate the gratifying results that can be obtained with this technique.

CONCLUSIONS

In selected sites and patients, the freehand graft is a rapid and convenient method of harvesting skin. When harvested from the preauricular cheek and subauricular neck, the graft is a good match to cover sun-exposed defects of the nose and ear. The major advantages of the freehand technique are that: 1) it expands the number of potential donor sites from which to select the most compatible skin to cover facial defects; 2) it allows the surgeon to efficiently configure the graft to the desired shape and depth to conform to the cosmetic unit or defect that is being reconstructed; 3) it does not require a dermatome or other specialized instrument to perform; and 4) it achieves wound repair with good appearance and function. The freehand partial-thickness skin graft has become our preferred method of grafting superficial facial defects.

Scalpel sculpturing techniques for graft revision and dermatologic surgery

BACKGROUND

Postoperative scars can be revised by a variety of techniques, including dermabrasion, laser, curettage, razor blade, and scalpel surgery. Most modern methods of scar revision provide good results but at the expense of time and economy.

OBJECTIVE

We present our scalpel sculpting technique that uses the #15 scalpel blade to microshave and feather the skin edges to equalize differences in skin elevations caused by uneven healing. The superficial wounds then heal by second intention.

METHODS

Sculpting techniques were used to revise side-to-side closures (grafts and flaps), trap-door elevations, standing tricones and hypertrophic scars. In addition, we used the sculpting technique to remove superficial blemishes such as actinic and seborrheic keratoses, skin tags, and other benign lesions.

RESULTS

We have used scalpel sculpting techniques to revise scars and remove blemishes for more than 5 years. We have removed thousands of skin imperfections with very gratifying results.

CONCLUSION

Scalpel sculpting techniques provide a simple, efficient method of scar revision and removal of superficial skin lesions. The technique reduces operative time and streamlines instrument reprocessing. Because of its simplicity, there is a high degree of patient, nursing, and physician satisfaction.