To Be, Notch to Be
26 March 2020 (online)
The use of full-thickness grafts (FTG) to resurface small to medium-sized wounds are popular in plastic surgical practice due to good aesthetic outcome and primary closure of the donor site. However, complication like wound dehiscence of the donor site is a limitation, especially in cases of a large area of harvest, where the wound is tightly closed. Conventionally, FTG is taken in a biconvex shape to facilitate the closure. In our clinical practice, we observed that the central portion of the wound bears maximum tension; hence, it is more prone to dehiscence. After seeing a few cases of dehiscence over the years, we propose a simple modification in the design of graft that both facilitates closure and prevents dehiscence. We call this “notch design” as its shape looks like a notch on smartphone display.
The groin is the preferred donor site for most FTGs. Laxity of skin and presence of natural groin crease augments harvest of large size grafts and aids primary closure of donor site. As large as 25 × 20 cm2 FTG has been described, where surgeons achieved primary closure, but a study by Kim et al mentioned donor wound dehiscence complication rate up to 6% for maximum dimensions of 8 cm × 13 cm.
In our cases, we have taken grafts of width ranging from 2 cm to 9 cm and length from 5 cm to 13 cm. These are most commonly used in patients of syndactyly for resurfacing post release. We have used small pieces of full grafts as per need of defect. In traditional described elliptical design, the ratio of width to length is 1:3, which is reliable enough to achieve the primary closure. Observing the nature of wound dehiscence in the center ([Fig. 1]), we concluded that most common site of dehiscence is the central part of the wound, due to maximum width, in turn, it had to withstand maximum tension ([Fig. 2]).
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