What is a bolster dressing on a skin graft?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: December 8, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Bolster Dressing on Skin Grafts: Definition and Technique

What is a Bolster Dressing?

A bolster dressing is a traditional fixation method for skin grafts that applies uniform pressure to ensure graft adherence to the recipient bed, consisting of a non-adherent interface layer, cushioning material (fluffed gauze or foam), secured with tie-over sutures or staples, and covered with an outer bandage. 1

Standard Components and Technique

The conventional tie-over bolster dressing includes the following layers 2, 1:

  • Non-adherent interface: Placed directly on the skin graft to prevent adherence and trauma during dressing removal
  • Fluffed gauze or foam bolster: Provides cushioning and distributes pressure evenly across the graft surface 2
  • Tie-over sutures or staples: Long sutures left at the graft periphery are tied over the bolster material to secure it in place 1
  • Outer bandage or compression: Additional wrapping to maintain the construct and provide external stabilization

Mechanism of Action

The bolster dressing works by applying external pressure to eliminate dead space between the graft and recipient bed, preventing hematoma and seroma formation while promoting graft adherence 2. The technique requires surgical skill to achieve appropriate tension, particularly on irregularly curved surfaces where inadequate pressure can produce hematoma, dislocation, or graft wrinkling 2.

Clinical Performance and Limitations

Effectiveness Concerns

The tie-over bolster dressing has notable limitations in specific anatomical locations 1:

  • Take rates in irregular, high-mobility areas: Only 81.7% graft survival in challenging locations such as joints or contoured surfaces 1
  • Complication profile: Higher rates of graft displacement (9 patients in one study) compared to alternative methods 1
  • Technical demands: Requires 27.4 ± 4.3 minutes for application and demands experience for optimal results 1

When Bolster Dressings Perform Adequately

For small, flat grafts in low-mobility areas, bolster dressings may be unnecessary 3, 4:

  • Simple perimeter sutures with light dressing achieved 100% graft take in small full-thickness skin grafts (8-45 mm diameter) on relatively flat surfaces 4
  • No significant differences in take rate, healing period, or complication rates between tie-over and non-tie-over groups in a 266-patient retrospective study 3

Modern Alternatives

Negative-pressure wound therapy has demonstrated superior outcomes compared to traditional bolster dressings, particularly in irregular, high-mobility areas, with graft take rates of 97.6% versus 81.7% for bolster dressings. 1

Advantages of Negative-Pressure Systems

  • Uniform force application: Applies suction to pull the entire graft onto the recipient bed rather than external pressure 2
  • Reduced complications: Significantly fewer graft displacements (1 versus 9 patients) 1
  • Time efficiency: Dressing application time of 15.2 ± 4.2 minutes versus 27.4 ± 4.3 minutes for bolster dressings 1
  • Overall take rate: 97.2% versus 90.2% for conventional bolster dressings 1

Clinical Caveats

Bolster dressings remain necessary for sites with free margins (eyelids, lips, nostrils) where tape fixation is difficult, but alternative dressings with polyurethane foam are useful in most other cases 3. The uneven pressure application from bolster dressings can prolong operative time and cause hematoma and seroma formation 3.

References

2
Research

Skin graft fixation with negative-pressure dressings.

The Journal of dermatology, 2003

4
Research

Tie-over bolster dressings may not be necessary to secure small full thickness skin grafts.

Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 1998

Related Questions

What is the usual duration before the first dressing change and management protocol for the bolter (bolster) dressing technique on skin grafts?
What is the procedure for applying a bolster dressing on split skin grafts?
What are the risks and complications associated with bolster use and how can they be minimized?
How to manage a sloughy skin graft on the midthigh of a patient with a history of midshaft fracture treated with a long intramedullary (IM) nail, distal femur fracture, and rhabdomyosarcoma treated with radiotherapy?
What are the systemic associations of Retinitis Pigmentosa (RP)?
How do you measure right ventricle (RV) systolic pressure using an echocardiogram (echo) image?
Does a male child scapegoated by a vulnerable covert narcissist parent develop narcissistic personality disorder (NPD)?
What is the most likely diagnosis for a patient with scissoring gait and periventricular leukomalacia on MRI?
What are the guidelines for managing hypertension?
What are the implications and management of false positives in Serum Protein Electrophoresis (SPEP)?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question