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Case Example Split Thickness Skin Graft STSG Zimmer Dermatome settings

last modified on: Wed, 02/28/2018 - 12:33

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Case Example Split Thickness Skin Graft  (STSG) with harvest technique, followup, and wound care

S/P "Moat" Procedure for lentigo maligna surrounding invasive melanoma

Moat Procedure: refers to circumferential clearance of margins by Mohs procedure to ensure adequate peripheral margins - like a "moat around castle"  (see references below re: margins for melanoma in situ and 'square' procedure).
see also: Case Example Lip Reconstruction Peri-alar Crescentic Advancement Flap

see videos at bottom of page
return to: Split Thickness Skin Graft  or Full thickness skin graft
see also: Skin Graft Donor Site Care   and     Zimmer Air Dermatome Instrument Tray

POD#1 after Mohs circumferentially around lentigo maligna. The defect creasted by revmoving the margin was sutured closed for comfort and to decrease bleeding prior to definitive resection.
Definitive resection done of melanoma arising in a field of lentigo maligna
   
   
Adjustable setting on Zimmer Dermatome with usual split thickness skin graft between 0.015 and 0.018 inches thick
 
       
       
     
Postop Day 34
Postop Day34
Post-op 6 months
Post-op 6 months
Post-op 6 months

References:

  1. Demirci H, Johnson TM, Frueh BR, Musch DC, Fullen DR, and Nelson CC: Management of periocular cutaneous melanoma with a staged excision technqiue and permanent sections - the square procedure. Opthalmology 2008 Dec;115(12):2295-2300
  2. Jejurikar SS, Borschel GH, Johnson TM, Lowe L and Brown DL: Immediate, optimal reconstruction of facial lentigo maligna and melanoma following total peripheral margin control. Plast Reconstr Surg. 2007 Oct;120(5):1249-55
  3. Kunishige JH, Brodland DG, and Zitelli JA: Surgical margins for melanoma in situ. J Am Acad Dermatol 2012 Mar;66(3):438-44
  4. Blum A:The moat technique. A two-step surgical technique for extensive basal cell carcinomas of the lip Der Hautarzt 2004 vol:55 iss:9 pg:869-873
  5. Hoffman HT and La Rouere M: A Simple bolster technique for skin grafting. Laryngoscope 1989 May;99(5):558-9