Title: Dermis Graft For Wound Coverage
Authors: Seung-Kyu Han MD PhD, Tae-Hwan Yoon MD, Jung-Bae Kim MD, and Woo-Kyung Kim MD, PhD
Source: Plastic and Reconstructive Surgery . 2007; 120:166-172.
PODIATRIC RELEVANCE:
Podiatric surgeons treat many foot and ankle soft tissue deficits. This article presents a way to obtain better cosmetic and more viable outcomes with dermis graft wound coverage as compared with traditional skin grafting techniques.
Surgical Technique:
The authors first used a Zimmer dermatome set at 0.010 inches at the donor site. They peeled back the first layer leaving it attached to the donor site and then reset the blade to 0.012 inches. They repeated the cut at the same site and adjusted the dermatome to 0.016 inches then ran it over the same donor site again. The dermal graft (the layer beneath the epidermis) was cut free from the donor site. The epidermis was folded back over donor site and sutured down. The dermis graft was applied to the recipient site and sutured in place. Sutures were removed at 5 days. Patients avoided sunlight for 3-6 months.
METHODS:
Over the course of 3 years, 53 patients were treated with the dermis-graft and 33 patients were treated with the traditional split-thickness skin graft. This article compared the rate of healing, the characteristics of the scar, and the personal satisfaction of the patients from April, 2001 to March, 2004.
RESULTS:
Grafts healed in all dermis graft patients within 15.5 +-1.9 days with good skin quality (3.7 days slower than traditional skin grafts which healed in 11.8 +-1.6 days). Scars were superior to the regular skin graft based on pigmentation, height, and vascularity. There was no difference in pliability.
All of the donor site wounds healed within 9 days (2-7 days less than normal skin graft donor sites). Patients were more satisfied with the dermis graft donor site scar than the traditional skin graft donor site healing. Patients had no complications and no functional scar problems.
COMMENTS:
Dermis grafts took longer to heal in large wounds. This article does not have any data on the most appropriate size or thickness of the dermis graft to have wounds heal without scars. There is also no study comparing this technique with healing by secondary intention. This article is a good study however, more research should be done comparing this technique to other types of grafts including synthetic grafts.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.