A skin graft involves transplanting skin from one area of the body to another to cover wounds, promote healing, and restore skin integrity.

01 - Patient Setup

Pre-op Meds: Ancef, Clindamycin if PCN allergy

Anesthesia:  General

Patient position: Supine

Bed position: No turn

DVT ppx:  Compression boots on - working BEFORE induction of anesthesia

Side Table: N/A

Lights: Overhead only

Power: 2 Bovie Machines

Bovie Settings: 50/50

Preinjection: None

Prep:  Chloraprep

Drapes: Universal

Instrument sets:   Plastics major set

03 - Post-Op Information

Admission status: Same Day Surgery

Estimated time: 3 hrs

Coding:  19318-50, 611.1, 724.2, 724.4

Post-op wound care:  Drains out AM prior to D/C

Post-op activity restrictions:  No heavy activity for 24 wks

Follow up:  1 wk

Post-Op Instructions obtain from MedConnect

04 - HY Tips

02 - Case Details 

Special Instruments: Dermatome, mesher, carrier, Marcaine 0.5%, Exparel, mineral oil

Devices/Implants: N/A

Hypodermic needles:  20-gauge or larger spinal needle

Syringes: 60 cc Luer-Lok syringe x 2

Drains: 2 #15 Blake Drains

Suture: 3-0 chromic SH 

Anesthesia on field: Tumescent solution on the field (500 cc of injectable LR or normal saline with 1 amp of epi

Dressing:  

- Recipient site: Black VAC sponge split in half, Adaptic, extra DermaTAC tape versus ioban, hospital VAC, Mastisol

- Donor site: Mepilex Ag (standard, not the transfer dressing), ABDs, Ioban, Webril 6 in, Ace 6 in x2

Skin graft harvest:

1. Ensure the dermatome is functioning and assembled correctly with the blade labeled "This side up" and covered with a 3-inch guard (avoid 4-inch and 2-inch guards).

2. Set the thickness to 0.010 inches for Dr. Kleiber patients; increase to 0.012 inches if no tumescent is used

3. Wipe off all ChloraPrep solution from the thigh with a wet lap to prevent the dermatome from sticking.

4. Apply minimal oil to the donor site and dermatome gliding surface.

5. Use multiple assistants to provide traction in various directions to ensure a flat surface on the thigh.

6. Harvest the skin graft with the dermatome at a 30 to 45-degree angle.

7. Mesh the graft to the desired ratio. Use the carrier with the dermis side up for correct placement.

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Tips for Dressing:

1. Make an imprint of the VAC sponge on the recipient site and cut it to match precisely.

2. Place Adaptic onto the sponge and staple it in place (skip this step for Dr. Tom, who does not use Adaptic).

3. Border the recipient site with Mastisol or Duoderm if it's a moist area.

4. Use Ioban to expedite taping the sponge down.