ISKIN GRAFTING Manual Technique 1. Preparation a. Prior to crafting the recipient site should be prepared as well as possible – high quality granulation tissue without infection and without movement provides the best opportunity for a good outcome. b. Care should be taken to ensure that the granulation tissue is healthy prior to grafting. It is useful to reduce any excessive granulation tissue by surgical debridement. This serves to remove any superficial infection and reduces the amount of granulation tissue that has to be removed later on. This is best performed a day or two before pinch grafting i. Please note that pinch grafting is tolerant of variations in granulation tissue quality at various areas within the wound bed. It is also more tolerant of movement and minor infection. 2. Collection of grafts a. Donor pinch grafts are usually harvested from the side of the neck (under the mane) or the breast; b. The donor site should be clipped and washed and then rinsed over with alcohol c. Local anaesthetic solution is laid in a line around the periphery of the donor site and left for 10 minutes d. A right handed operator should hold the needle driver in the left hand and grasp the half curved large, cutting suture needle about half way along its length so that the point is directed to the right! e. The number 15 (or 11) scalpel is held in the right hand f. The skin is just lifted with the point of the suture needle and the blade is used to cut a disc of skin around it. It helps to avoid excessive lifting tension and it helps to cut directly at right angles to the needle. Grafts should be around 2-3 mm across and roughly circular and saucer shaped in profile – deeper (full thickness) in the central and split skin thickness at the margins with sloping edges Variation in graft size is common and is of no significance – grafts less than 1 – 2 mm in size are not suitable and grafts over 5 mm in size are really too big It is useful to change the blade frequently because inevitably that will contact the metal of the needle and get blunt very quickly. This results in a poor harvesting technique g. Grafts should be harvested from the most ventral part of the donor site first to avoid blood spreading across the site and making collection problematic. h. Grafts are placed carefully into a sterile pot or petri dish and should be used as soon as possible. There is no known advantage to placing them on a saline soaked swab. NOTE: It may help to have one operator collecting the grafts whilst another person implants the grafts i. There is no advantage in trying to close the donor sites with staples or sutures – they will look slightly bigger by 24 hours post procedure but thereafter will heal rapidly by contraction and epithelialisation. By 7 days they are usually just a small scab and by 14 days they are imperceptible in most cases. In a few cases a few white hairs may develop at the donor site so it is worthwhile warning the owner first. Unhealthy Healthy granulation tissue granulation tissue www.kruuse.com
Download PDF file