Fast and Standardized Skin Grafting of Leg Wounds With a New Technique

Report of 2 Cases and Review of Previous Methods

Nils Hamnerius, MD; Ewa Wallin, RN; Åke Svensson, MD, PhD; Pernilla Stenström, MD, PhD; Tor Svensjö, MD, PhD

Disclosures

ePlasty. 2016;16 

In This Article

Materials and Methods

The Xpansion MicroAutografting Kit (Applied Tissue Technologies LLC, Newton, Mass)* is a sterile, single-use disposable kit that contains a nonpowered handheld dermatome (Fig 1a) for harvesting a skin graft, a nonpowered handheld mincer for processing the graft into fine particles, as well as related supplies. The dermatome has a plastic handle with a surgical blade that is set at a fixed angle and exposure that allows for the dermatome to be held flat to the skin to harvest a graft (Fig 1b) approximately 0.32 mm (0.012 in) thick. The graft was transferred with forceps to a small cutting mat. The mincer has a plastic handle with an array of circular blades mounted in parallel on an axle. The device was rolled over the graft once to cut the graft into fine strips (Figs 1c and 1d), and again at a 90° angle to cut the strips into particles approximately 820 μm[2] (Fig 1e). These particles were spread evenly across the wound bed (Fig 1f). No attempt was made to orient the particles in any particular direction since previous pig experiments performed by Hackl et al[29] have shown that orientation of the skin grafts is not necessary. The grafts were covered with a silicone dressing (Mepitel; Mölnlycke Health Care, Gothenburg, Sweden) and a foam dressing (Allevyn, Smith and Nephew, Mölndal, Sweden, or Mepilex, Mölnlycke Health Care). The venous ulcer was also bandaged with a multilayer compression bandage system (Profore; Smith and Nephew). The acute wound was also covered with a silver dressing (Acticoat; Smith and Nephew) to prevent infection and a light compression bandage. Dressings were changed when necessary. Sterility was maintained during the initial procedure. Donor sites were located on the anterior thigh and were covered with a combined silicone foam dressing (Mepilex Border, Mölnlycke Health Care). Local anesthesia was managed with subcutaneous injection of Mepivakain (10 mg/mL) with epinephrine (5 μg/mL). After transplantation, the patients were asked to maintain a mild physical activity and to have their grafted legs elevated whenever sitting or lying.

Figure 1.

Transplantation procedure. (a) The handheld dermatome is run back and forth with mild pressure over the skin that has been moisturized with saline. (b) An approximately 4-cm2 STSG graft has been harvested and laid onto the cutting mat, which was wetted with a few droplets of saline. (c) The handheld mincer is run first once over the STSG and then once more in a 90° angle in relation to the first time. (d) The mincer has an array of circular blades mounted in parallel on an axle. Any skin fragments that stick to the mincer are removed with a spatula and transferred to the other fragments on the cutting mat. (e) Close-up of the skin fragments approximately 800 × 800 μm in size. Sometimes an extra run with the mincer is necessary to obtain complete mincing. (f) The skin fragments are kept together and spread out onto the wound bed. STSG indicates split-thickness skin graft.

*The Xpansion MicroAutografting Kit is distributed by SteadMed Medical LLC, Fort Worth, Tex.

processing....