Split Skin Graft (SSG)

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Rationale

-  Application of thin dermal layer of skin grafted from donor site to repair skin defect

 

Indications

-  Full thickness skin defect from wound: ulcer, haematoma, trauma, skin cancer excision..

-  Typically large in size making flap or full thickness graft less preferable

 

Features

-  More suitable for limbs

-  Requires some granulation for base of wound for graft to take

-  +/- VAC to assist granulation

-  Less vascular than FTSG

-  Arteries form first, veins slow to form

-  Generally contracts (unlike FTSG)

-  Deramtome turns skin into a mesh

-  Increases surface area to approx x1.5

-  Can be used to cover large surface area

-  Allows exudate to drain, prevent collections

 

Equipment

-  Dermatome

-  Mesh (w ratchet)

-  +/- Skin stapler

 

Procedure

-  Measure & mark donor site

-  Area needs to be bigger than recipient site

-  Prep area w betadine

-  Apply dermatome to area under tension

-  Ensure good contact with skin

-  Pattern of bleeding indicates consistency of dermatome

-  Carefully remove skin graft from dermatome onto mesh

-  SSG on mesh run through ratchet

-  Keep moist w NS

-  SSG applied to donor site

-  Apply with superficial surface up (correct orientation)

-  +/- skin staples to secure edges

 

Post-Op

-  To promote uptake of graft aim for

-  Albumin >35

-  Hb >10.0

-  If lower limb

-  RIB +/- toilet privelages for 5/7

-  DVT prophylaxis: Enoxaparin + contralateral TEDS

-  Gentle mobilization after 5/7

-  Progressive increase in activity up to 2/52 post graft

-  SSG

-  Jelonet + gauze  +/- Daniel Robinson dressing (double Velband + crepe)

-  Dressing intact 5/7 with immobilisation of region then R/V

-  Daily dressing post R/V

-   Clean w normal saline & dry

-   Jelonet overlapping edges of graft

-   Gauze to size of graft & fill to skin level if needed

-   Crepe bandage over the top

-   Double layer of tubigrip

-  Donor Site

-  LA soaked Kaltostat dressings over donor site

-  Donor site dressing intact for 10-14 days

-  Then for R/V

-  Sorboline BD post R/V

-  If hypergranulation can use Chlorsig ointment OR Kenacomb