return to: Full thickness skin graft or Case Example T1a Lentigo Maligna Melanoma Resection with Porcine Graft Reconstruction or Reconstructive Procedures Protocols
see: Case Example Split Thickness Skin Graft STSG Zimmer Dermatome settings; Full Thickness Skin Graft from medial upper arm donor site
Operative Note
The right temple dressing and porcine graft were removed. The area was infiltrated with about 5 cc of 1% lidocaine with 1:100,000 epinephrine. The post-auricular area was infiltrated with about 10 cc of 1% lidocaine with 1:100,000 epinephrine. The defect template was made and used to outline the postauricular incision that was based 1/2 on the post-conchal bowl and 1/2 on the mastoid. The incision was made with a 15 blade in an elliptical fashion the skin graft was raised in the subdermal plane. Subcutaneous tissue was removed. The graft was sutured into the defect with 4-0 chromic. The graft was pie crusted and a bolster was sutured with 5-0 prolene. The post-auricular defect was undermined and then reapproximated with 1/2 buried horizontal mattress 4-0 nylon sutures. The skin was reapproximated with simple 4-0 nylon sutures. A rubber band drain was placed and sutured. Bacitracin was applied. The patient tolerated the procedure well.
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Telfa bolster over porcine graft (post-op day #4); ready for FTS |
Porcine xenograft in place; ready for removal and replacement with FTSG |
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The full thickness graft is thinned to dermis with fat removal |
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Undermining posteriorly will allow the soft tissue to advance with 3-0 nylon 'half-buried mattress' sutures |
Entry through skin, engaging deep tissue anteriorly (needle placement showing), and replacement back through skin permits the half-buried mattress suture to advance the skin and obliterate dead space |
Four separate 'half-buried mattress' sutures in place with closure |
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Full thickness skin graft secured with 4-0 chromic; layers above FTSG: bacitracin, adaptic, telfa (several layers of telfa) secured with 5-0 prolene |
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3 Months followup comparing donor side to unoperated side