What are the operative notes for a split-thickness skin graft (STSG)?

From the Guidelines

Operative notes for a split-thickness skin graft (STSG) should document the entire surgical procedure comprehensively, including patient identification, date, time, surgeon names, anesthesia type, and informed consent, as well as preoperative and postoperative diagnoses. The notes should detail the skin graft harvesting, including donor site location, thickness, dimensions, and harvesting method, as described in studies such as 1. Some key points to include are:

• Donor site location, commonly the thigh, buttock, or abdomen
• Graft thickness, typically 0.010-0.018 inches
• Graft dimensions and harvesting method, including dermatome type and settings
• Recipient site preparation, including debridement, hemostasis methods, and wound bed assessment
• Graft meshing, placement, and securing methods, such as sutures, staples, or adhesives
• Dressings applied to both donor and recipient sites, including primary dressings, secondary absorbent layers, and immobilization methods
• Estimated blood loss, complications, and immediate postoperative assessment of graft appearance
• Postoperative instructions, follow-up plans, and any specific concerns, as outlined in studies like 1 and 1. It is essential to note that the choice of closure technique, including STSG, may be guided by anatomical considerations and the availability of suitable donor skin, as mentioned in 1. Additionally, studies such as 1 and 1 provide guidance on reconstruction and surgical management of tissue damage, which may be relevant to STSG procedures. However, the primary focus of the operative notes should be on documenting the STSG procedure itself, as this is crucial for tracking surgical outcomes, planning future care, and addressing any complications that may arise during healing.

From the Research

Operative Notes for Split-Thickness Skin Graft (STSG)

• The operative notes for a split-thickness skin graft (STSG) involve several key steps, including meticulous debridement of the recipient site, coagulation of venous bleedings, and preparation of the recipient site for skin grafting 2.
• The split-thickness skin graft is then harvested and, if necessary, modified by the meshing procedure 2, 3.
• The skin graft is placed in the defect and fixated at the wound margins, and a special compression dressing is used to cover the split-thickness skin graft to promote healing 2.
• The compression dressing is typically left in place for 5 days, after which daily changes are done using double layers of fatty gauze, alternated with periods without dressing 2.
• In some cases, negative pressure wound therapy (NPWT) may be used as a bolster to support the STSG, particularly in diabetic patients with foot and ankle wounds 4.
• The use of NPWT has been shown to result in consistent improved outcomes compared to alternative bolstering techniques, with an average time to heal of 17 days 4.
• However, other studies have found that conventional dressing of STSGs is not inferior to NPWT, and may be easier to use and less expensive to apply, with a higher skin graft take rate and lower infection rate 5.

Post-Operative Care

• Post-operative care for STSG involves monitoring for complications such as infection, hematoma formation, and graft loss 2, 3, 5.
• Patients should be followed up regularly to assess the STSG take rate, wound healing, and any potential complications 2, 5.
• The use of NPWT or conventional dressing should be tailored to the individual patient's needs and wound characteristics 4, 5.