What are the operative notes for a split-thickness (STSG) skin graft from the left thigh to the right foot?

From the Guidelines

A split-thickness skin graft procedure from the left thigh to the right foot involves harvesting a graft with a dermatome set to a specific thickness, typically 0.012-0.015 inches, and securing it to the recipient site with sutures, staples, or adhesive. The procedure begins with preparing both the donor site (left thigh) and recipient site (right foot) by cleaning and draping them under sterile conditions. The recipient site on the right foot is debrided of any nonviable tissue and prepared to receive the graft.

• Key steps in the procedure include: + Harvesting the graft from the left thigh using a dermatome + Transferring the graft to the recipient site on the right foot + Securing the graft using sutures, staples, or adhesive + Applying a non-adherent dressing to the graft site, followed by a bolster dressing
• The choice of wound closure technique, including split-skin grafting, may be guided by anatomical considerations and the availability of suitable donor skin 1.
• Meshing of the graft may be performed if needed to cover a larger area or to allow for drainage, as meshed split-skin grafts are the technique most commonly employed 1.
• Post-operatively, the patient is instructed to minimize movement of the grafted area for 5-7 days to allow for graft adherence and revascularization.
• The procedure is effective because it provides immediate wound coverage while allowing the patient's own skin to heal the defect permanently, although there is insufficient evidence to indicate that any one modality is associated with better healing than another 1.

From the Research

Operative Notes for Split-Thickness Skin Graft

The operative notes for a split-thickness skin graft (STSG) from the left thigh to the right foot involve several key considerations:

• Donor site selection: The basic principle of donor site selection is to take skin from areas that will heal with minimal scarring while balancing the needs of the recipient site 2.
• Graft harvesting: The graft can be harvested using a hand-held knife, with a technique to determine the appropriate setting for the knife to provide skin of adequate thickness 3.
• Graft thickness: A split-thickness skin graft of 0.014 in. thick can be harvested from a non-weight-bearing area of the foot or from the anterior or posterior thigh 2.
• Anesthesia: The donor site can be anesthetized using a single pass technique with hyaluronidase to uniformly anesthetize the site with one injection of one needle 4.
• Donor site management: The donor site can be managed with various dressing materials, with Aquacel® Ag and Comfeel® Plus Transparent being among the most effective options 5.
• Graft application: The graft can be applied to the recipient site on the right foot, with meshing of the graft to cover the defect.

Postoperative Care

Postoperative care for the donor site and recipient site is crucial for optimal healing:

• Donor site care: The donor site should be dressed with a suitable material and monitored for signs of infection or delayed healing 5.
• Recipient site care: The recipient site should be monitored for graft take, infection, or other complications, with regular dressing changes and wound care as needed.
• Pain management: Pain management is important for both the donor and recipient sites, with options including local anesthetics and pain medication as needed 4, 5.