What are the step-by-step operative notes for skin grafting?

From the Guidelines

Skin grafting operative notes should follow a structured format, including patient identification, procedure name, surgeon information, anesthesia type, and indication for grafting, with a focus on meticulous preparation and execution to optimize outcomes. When considering the step-by-step approach for skin grafting, it's crucial to prioritize techniques that minimize morbidity, mortality, and improve quality of life. According to the guidelines for managing cutaneous squamous cell carcinoma in patients with epidermolysis bullosa 1, split-skin grafting has been the most frequently employed technique, often with meshing, despite potential complications such as delayed healing of donor sites.

Preoperative Preparation

• Patient identification and procedure details
• Marking the recipient and donor sites
• Administration of appropriate anesthesia
• Preparation of the recipient site, which may include debridement of nonviable tissue and achieving hemostasis

Graft Harvesting and Preparation

• Harvesting the graft using a dermatome for split-thickness grafts or a scalpel for full-thickness grafts, with specification of the thickness and dimensions
• Preparing the harvested graft, which may involve removing excess fat for full-thickness grafts or meshing for split-thickness grafts to cover larger areas

Graft Placement and Securing

• Placing the graft on the recipient bed, oriented to minimize contracture across joints
• Securing the graft with sutures, staples, or fibrin glue
• Dressing the graft with non-adherent material, bolster dressing, or negative pressure therapy, depending on the site

Postoperative Care

• Documentation of hemostasis, estimated blood loss, and any complications
• Providing postoperative instructions, including immobilization requirements, follow-up timing, and the schedule for the initial graft check Given the lack of evidence indicating that any one modality is associated with better healing than another 1, the choice of closure technique, such as autologous split skin, epidermal grafting, or full-thickness grafting, should be guided by anatomical considerations and the availability of suitable donor skin or alternatives like skin equivalents.

From the Research

Preoperative Preparation

• The preoperative preparation for skin grafting involves a systems approach to reduce the risk of surgical site infections 2
• This approach includes an antiseptic bath or shower within 24 hours before surgery, followed by a Food and Drug Administration-compliant patient preoperative skin preparation at the time of surgery 2
• The goal of surgical skin antisepsis is to remove soil and transient microorganisms living on the skin that could pose a risk for surgical site infections 3

Operative Notes

• The operative notes for skin grafting are not explicitly stated in the provided studies, but it can be inferred that the procedure involves:
  • Preparation of the recipient and donor sites 4
  • Intraoperative wound bed preparation to promote adequate graft take 5
  • Application of topical agents such as silver sulfadiazine or collagenase ointment to the wound bed 6
• The use of sharp debridement prior to grafting and the application of topical gentamicin intraoperatively may also be part of the operative notes 5

Postoperative Care

• The postoperative care for skin grafting involves promoting wound healing and successful graft take 4
• This may include the use of topical agents, dressing changes, and monitoring for signs of infection or graft failure 4, 5, 6
• The patient's demographics, days from burn to graft, and percentage of total body surface area (TBSA) grafted may also be important factors to consider in postoperative care 5