Split Thickness Skin Graft using the Dermatome & Mesher
Split thickness skin graft is a graft where only part of the skin; the Epidermis & part of the dermis will be taken from the donor site, leaving the donor site with rest of the dermis left intact. The amount of dermis taken for the graft will be determined by the surgeon. This type of grafting is done when the patient has a wound that cannot be closed because of extensive loss of skin. These wounds can be a result of Trauma, Pressure Ulcers, Necrotizing fasciitis, Wide excisions,
etc. A Split thickness skin graft is an Auto-graft (the recipient & donor are one in the same) and can be used on any part of the body. The graft can be placed as sheet or meshed. Sheet skin grafts are primarily used on the head, neck, hands for aesthetic purposes while, meshed grafts are used on every other part of the body. The benefits of a meshed graft are that a smaller piece of donor tissue can be taken & expanded to cover a large area. Also, if there will be drainage
from the wound, such as blood or serous fluid it is able to escape through the meshed holes in the graft.
Zimmer Dermatome
Black lever on the side changes the width of the graft being taken. This adjustment is determined by the surgeon.
Disposable Blade for the dermatome
On the backside of the blade there are small nubs
The small nubs on the back of the dermatome blade will fit into the trough on the dermatome handle.
In addition to the nubs in the trough, the blade will be fully seated when the black nub on the dermatome handle seats in the hole on the blade.
Left
Dermatome handle w/ blade loaded
Right
Dermatome width plates. Depending on which plate is put on will determine the width of the graft being taken from the donor site. This is dependent on the size of the wound.
In this photo a 2″ Width Plate is being put on
The Width Plate is locked on with a screwdriver
This dermatome is powered by Nitrogen.
Attach the cord to the handle
Fully set up ready to go.
To allow the dermatome to glide smoothly on the donor site. The skin may be lubricated with mineral oil & held taught with a toungue depressor. As the graft is neing taken an assistant gently grasps the tissue coming through the dermatome & holds a little tension on it so that it will not bunch up & prematurely get excised.
Left to Right
– Derma carrier 1:1.5
– Mesher
– Mesher Handle
After the skin is excised from the donor site, it is placed dermis side down & flattened out on the rough side of the Derma Carrier. No wrinkles or folds. Adding a few drops of saline & gently smoothing it using the back end of a forceps really helps with this step.
(This photo actually shows a graft that has already been meshed)
Mesher w/ ratchet handle attached
Load Derma Carrier into Mesher, then crank handle to feed tissue through….do this in a steady motion….not too fast…
Another view of the Derma Carrier being loaded into the Mesher
Graft coming through on the other side
What the graft will look like after being meshed (kinda like fishnet stockings)
The mesh will now be placed dermis side down on the recipient site & secured with staples (or sutures)
