Skin graft videos
January 7, 2009 § 8 Comments
Two skin graft videos I’ve made were published on www.oncolex.org today. One of a full-thickness skin graft applied to the index finger after excision of a squamous cell carcinoma. The other of a split-thickness graft applied after removing two tumors from the back of the patient’s knees.
Full-thickness skin graft
The squamous cell carcinoma on the lower part of the patient’s right index finger is marked and 0,5 cm margins drawn around it. Local anesthesia is applied and left to work. Meanwhile the graft is harvested from the area over the palmaris longus tendon on the wrist of the same hand. The dermis is carefully separated from the underlying subcutaneous fat. The graft is put aside in a moist sponge and the harvest wound is closed with loop suture.
The tumor is excised with 0,5 cm margins to the sides and down to the paratendon. Before applying, any remaining subcutaneous fat is removed from the graft, so that only the dermis and epidermis remain. This is important to achieve good vascularization of the graft. Two holes are made in the graft with a scalpel, to allow wound fluid to escape through it rather than accumulating under it.
Split-thickness skin graft
This is a patient with squamous cell carcinomas on the back of both knees. The tumors are excised with wide margins to the sides and down to the muscle fascia. (I’m not entirely satisfied with this part of the video. Too many hands). The specimens are marked with sutures.
The graft is harvested from the back of the patient’s right thigh using an air pressure operated dermatome. The graft is moistened and put on a glass plate. This plate is then passed through a skin mesher which cuts small slashes in the graft. This allows the graft to expand in size and prevent accumulation of wound fluids under it. The meshed graft is stapled to the wounds and the edges are trimmed with scissors.
A vacuum-assisted closure (VAC) sponge is used as the wound dressing. A perforated silicone plate is placed over the wound and the sponge placed on it. The VAC tube is placed on the sponge and the entire arrangement sealed air tight around the wound with self-adherent plastic film. When suction is applied to the tube, vacuum is created in the wound. This promotes graft adherence and removes wound fluids and edema from surrounding tissues.