A simple skin graft knife for general use

A SIMPLE SKIN GRAFT KNIFE FOR GENERAL USE* LT. COMDR. G. V. WEBSTER, M.C. UNITED STATES NAVAL RESERVE URING recent years, a multitude machines and other of devices, contraptions for cutting skin grafts have been introduced by surgeons and surgical suppIy houses. NearIy all of them require the apphcation of a cement or other substance to the skin and in many cases, this makes the graft diflicuh to handle, particularIy when only smaI1 grafts are needed. There have been two reasons for the introduction of such a cohection of devices: (I) The vaIue of early skin grafting of burns and other surface defects has been irrefutabiy estabIished, and so there has been a great demand for grafts, especiahy of the spIit-thickness type described by BIair and Br0wn.l (2) It is wrongIy assumed that the average surgeon cannot cut a thick-spIit graft by a free-hand technic. Some utopian device has been sought whereby the needed graft can be obtained without hacking-up and morceIIating donor sites to the extent that sometimes a donor defect is created which is worse than the recipient site. Most surgeons have tried to cut a freehand graft from time to time and, having met with indifferent success, have turned to expensive and comphcated devices or have referred even simple cases to the plastic and reconstruction surgeon. WhiIe the latter is admittedly most desirable, there are a great many cases, particuIarIy with the current shortage of skilIed phy-

D

sicians and surgeons, wherein crippling deformity couId be prevented by early grafting by the genera1 surgeon, provided he is wiIIing to spend the time and pains necessary to prepare the recipient site and give proper after-care. AUTHOR’S

INSTRUMENT

The one instrument with which the genera1 surgeon has had the most success in cutting grafts is an old-fashioned straight razor. If the razor is sharp, nearly anyone can cut a graft by the free-hand technic with fair success. There are two difficulties, however, which are frequentIy encountered. The razor is cIumsy to hold and secondly, it is rarely sharp enough. To obviate these diffrcuhies a skin-graft knife has been constructed which consists of an inexpensive and rigid handIe and removabIe “ straight razor” singIe-edge blades” which can be purchased in packages of five for a few cents at the corner drug store. (Fig. I.) Such a knife is a remarkably successful instrument. (Fig. 3. j No suction box nor other apparatus is necessary. METHOD

OF

CUTTING

GRAFTS

The methods of preparing the recipient area are we11 pubhcized and are beyond the scope of this paper. It does seem * Week & Co., Brooklyn,

N. Y. ‘SextobIade’.

* From the Division of PIustic and Reconstruction Surgery, Department of Surgery, National Naval hledical Center, Bethesda, Md. The opinions or assertions contained herein are the private ones of the writer and are not to be construed as offlciaI or as reffecting the views of the Navy Department or the Naval Service at large. 5%

370

American

Journal

Webster-Skin

of Surgery

appropriate, however, to mention in some detaiI the exact method of cutting a graft by the free-hand technic.

A

B

FIG. 1. The author’s skin-graft knife. A, assembled; B, with removabIe blade (Week 81 Co. “sextoblade”) detached.

A donor site is seIected (usuaIIy the thigh for men and the buttock for women) and prepared by cleansing with green soap, removing the soap with ether and painting with tincture of iodine (334 per cent). The skin is then covered very IightIy with a thin fiIm of petroIatum and the excess scraped off with the edge of a steriIe tongue depressor.

Graft

Knife

The operator stands so as to be abIe to cut a graft from right to Iek, if he is righthanded or Ieft to right if he is Ieft-handed. His assistant stands on the same side as the operator and either above or beIow him depending upon whether the graft is being cut up or down the Ieg. It is the duty of the assistant to give countertraction by means of a flat surface such as a tongue depressor wound with gauze so that it wiI1 not sIip. (Figs. 2 and 3.) The operator hoIds in his Ieft hand a straight edge of some type, the most readily available of which is a steriIe tongue depressor. (Figs. 2 and 3.) The assistant has in his free hand a pair of forceps with which to steady the graft as it comes over the back of the knife. The nurse hoIds a sponge wet with normal saline and drips a few drops on the bIade shouId they be required to moisten and Iubricate the knife. With a good Iight on the field, the operator begins a IongitudinaI “to and fro” motion with the bIade, steadying the skin with the tongue depressor in his left hand. The knife, which in the case of the author’s instrument wiI1 be absoIuteIy fresh and sharp, wiI1 sink into the skin to the required depth. Then, seemingIy without any conscious effort of pushing the knife forward, the blade travels into the skin and paraIle1 to the skin surface. Emphasis should be placed on avoiding any forward push of the knife. With the tongue depressor in the Ieft hand keeping just ahead of the bIade, the graft is cut, keeping the knife at that distance from the surface where the bIade looks sIightIy bIue beneath the severed graft. In this way, with cIose attention to detai1, grafts of uniform thickness and width can be cut to aImost any desired length. (Fig. 3.) Their width, .however, is Iimited to about two and one-haIf inches. If wider grafts are desired, the standard Blair knife, the Ferris Smith modification of the BIair knife, or the dermatome shouId be used. Even smaII grafts Iaid sideto-side can cover a huge surface area and

Ntw

SERIES

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LXVII.

ho.

3

Webster-Skin

the resuIting growing skin will serve all functions for which thick-split grafts are intended.

FIG.

2.

The position

of operator

Graft

Knife

American

Journal <,ISu,-g~r\,

571

hand technic because there is provided an extremely sharp bIade and a convenient handIe. Only a IittIe practice is necessari

and assistant as graft-cutting begun.

operation

is

FIG. 3. Graft being removed. Note uniform thickness, even edges and simpIicity with which graft is cut. The graft is retracted as it Iies on the bed from which it was removed, but yields a fuII two-inch width with ease. SUMMARY

A simple, inexpensive skin graft knife is presented which utilizes two and onefourth inch removabIe packaged razor blades. The knife can be used easily by even inexperienced operators to cut Thiersch or thick-split grafts by the free

to acquire facility which will give the general surgeon a ready source of skin grafts for a muItitude of purposes. REFERENCE

I. BLAIR,V. P. and BROWN, J. B. Use and uses of large split-skin grafts of intermediate C+nec.& Ohst., 49: 82, 1929.

thickness.

Stq.,