The meshing of grafts has given a considerable boost to the concept of expanding the area which an individual graft is able to cover, previously only possible by dividing it into stamps. The graft, cut in the usual way, is passed through an instrument from which it emerges shredded into a regular meshwork of skin. […]

Pressure is usually applied in two ways. It is applied directly and very precisely to the graft by means of a bolus overlying the graft, the sutures used to fix the graft in position around the margin of the defect being left long and tied over the bolus to hold it in position. It is […]

A skin graft can be applied to a defect in one of two ways: with pressure applied to the graft, or with the graft left exposed. If full use is to be made of the virtues peculiar to each of these methods it is essential to see how in different clinical situations each pro-vides close, […]

It is axiomatic that the granulating area is being treated, not its flora, and so antibiotics should not be used blindly on the basis of sensitivity reports. Str. pyogenes apart, the flora is largely immaterial provided the granulations look healthy, and the fastest way to eliminate the flora is to skin graft the area. In […]

In assessing a granulating area for grafting two factors are of importance -clinical appearance and bacterial flora. 1. Clinical appearance Healthy granulations are flat, red and vascular, do not bleed unduly readily, and are free from a covering surface film.   Good marginal healing is presumptive evidence that granulations will accept a graft, for it […]

Free skin grafts are applied either to raw surfaces surgically created, or at least surgically clean, or to granulating wounds. The practice of grafting varies with the two types of surface as does preparation for grafting. THE SURGICALLY CLEAN SURFACE Preparing the recipient area Although a full thickness skin graft or split skin graft may […]

Management of the donor area has been, and to some extent still is, one of the less satis-factory aspects of skin grafting. The problems are pain, the provision of the optimal local environ-ment for the healing process, and removal of the dressings. Pain usually settles within 3-4 days, and is often followed by itching. Although […]

Instruments are less able to do with comparable consistency. In appearance it is not unlike a large hair-clip-ping machine , and the resemblance is maintained in action with the rapidly oscillating cutting blade which is driven electrically or by compressed air. With the skin held steady, and lubricated with liquid paraffin, the instrument is able […]

Although a setting of the roller has been sug-gested, the surgeon must be prepared to modify it if necessary. The first 6 mm or so of the graft cut provides an initial indication of its thickness and the setting can be adjusted accordingly.  The translucency of the graft is the main index of thickness. The […]

The instruments commonly used for cutting grafts are: 1. The Humby knife. 2. The power-driven dermatome. The Humby knife The instrument originally used to cut split skin grafts freehand was a knife with a blade approximately 25 cm long, referred to as a Blair knife after the American plastic surgeon who developed it. To cut […]