The immobilization of a skin graft is a key factor in its take of a skin graft.
Traditionally, a bolster dressing is used to secure and keep the graft immobilized
on its bed.[1] Its pressure obliterates dead space, and prevents hematoma and seroma formation.
This step usually falls toward the end of a long surgery, when anesthetic time may
be at a premium and surgeon fatigue at its peak. Here, we describe a new method of
graft immobilization which is effective, fast, and economical.
The method which uses a skin stapler and linen threads for bolster dressing is described
here.
The skin graft is placed over the prepared recipient bed and fixed in the following
manner. A free linen tie is placed over the margin of the wound, with one end long
and the other end short but adequately long to hand tie a surgical knot, and the stapler
is fired over the thread, fixing it to the graft and the bed (
[Fig. 1]
).
Fig. 1 Linen tie being placed across while the staple is being applied.
A surgical knot is then tied over the staple (
[Fig. 2]
).
Fig. 2 Surgical knot tied with the linen thread over the staple.
The required number of such linen ties and staples are placed over the margin radially.
A bolster dressing is placed over the graft, and the linen ties are tied over it in
the usual manner (
[Fig. 3]
).
Fig. 3 Multiple linen ties taken; inset shows the same tied over bolster dressing.
The traditional method of graft immobilization uses multiple sutures taken with a
swaged needle and tied over a bolster dressing. This requires multiple foils of suture
material, which is expensive and time-consuming.
A glove technique has also been described recently,[2] in which a sterile glove is cut open and is fixed with staples outside one margin
of the grafted wound, stretched over a cotton bolster, and then fixed outside the
opposite margin.
A modified bolster dressing with the use of continuous suction is also described in
literature.[3]
We have found the described “stapler and linen” technique to be quick, economical,
and simple, as linen ties are readily available in any OT, and the stapler is usually
already in use in the procedure.
