Sling sutures for skin graft donor sites

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Burns,9.66-67

Printed in Great Britain

Short Article

Sling sutures for skin graft donor sites M. J. Timmons Plastic Surgery Centre, Mount Vernon Hospital, Northwood, Middlesex

Summary

A technique is described using sling sutures for skin graR donor sites in order to takk the maximum amount of skin graft from difficult sites with a powered dermatome or a skin graft knife.

IN patients with extensive burns there are few potential skin graft donor sites. It may be difficult to take grafts from those areas available because of mobile underlying soft tissues, e.g. in the abdomen or buttock, or because of local rigid structures, e.g. ribs and vertebrae. At these sites, powered dermatomes are more efficient than skin graft knives used with conventional skin boards, but such dermatomes may not be available and even powered dermatomes can be difficult to use effectively, particularly in small children. Under these circumstances, sling sutures at the donor site edges allow grafts to be taken from otherwise awkward sites. MATERIALS

AND

METHOD

The sling sutures lift and tauten the skin (Fig. 1) so that a graft can be easily taken (Fig. 2) in regularly shaped sheets of the desired thickness (Fig. 3). With this technique, for example, good use was made of the limited area of skin available on a 5-year-old child’s abdomen between the costal margins and bums on the lower abdomen (Fig. 4).

Fig. I. Sling sutures lifting and tightening the skin.

DISCUSSION

The principles behind this technique are not new. Traction at the edges of skin graft donor sites was used in the earliest days of skin grafting (Poncet, 1871). Flick (1930) and later Clery (1950) used tension on Kirschner wires inserted subcutaneously to provide large flat taut areas of skin for donor sites. Gustavson (1974) and Tsur (1976) used sling sutures, together with other apparatus, for skin graft donor sites in experimental animals. The use of sling sutures for donor sites makes it possible to take the maximum amount of skin

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Fig. 2. Grafts can be taken in regularly shaped sheets of the required thickness.

Note Since this article was accepted for publication, R. J. A. Goris and J. P. A. Nicolai (Br. J. Plast. Surg. (1982) 35,58) have described a technique,

using the same principle, for taking skin grafts from the avulsed flap in degloving injuries.

REFERENCES

Fig. 3. Skin grafts taken from the limited area of skin on a 5-year-old child’s abdomen using the technique.

Clery A. B. (1950) Simple device to facilitate split-skin grafting. Br. J. Plast. Surg. 2, 290. Flick K. (1930) Verfahren zur Entnahme grosser Epidermislappen. Deutsch. Z. Chirurg. 222, 302. Gustavson E. H. (1974) A simple aid to taking splitthickness skin grafts in small experimental animals. Br. J. Plast. Surg. 27, 165.

graft from difficult sites with a powered dermatome or a skin graft knife, either in patients with extensive burns or those in whom it is desired to restrict the donor sites to areas acceptable cosmetically such as the buttocks. C‘orrr.spondmw should he uddressed f~: Mr Middlesex.

M. J. Timmons,

Poncet A. (187 I) Des greffes dermo-Cpidermiques et en particulier des larges lambeaux dermo-epidermiques. Lyon Med 8,494. Tsur H. (1976) Split thickness skin grafts from rats: a simple technique. Br. J. Plust. Surg. 29, 341. Paper accepted 17 December 198 I,

Plastic

Surgery

Centre,

Mount

Vernon

Hospital.

Northwood,