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Full Thickness Skin Graft - Retroauricular donor site - Clinical case example

last modified on: Tue, 10/17/2023 - 08:17

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 settingsFull 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.

 

Telfa bolster over porcine graft (post-op day #4); ready for FTS

Porcine xenograft in place; ready for removal and replacement with FTSG

   
   

The full thickness graft is thinned to dermis with fat removal

 

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

 

Full thickness skin graft secured with 4-0 chromic; layers above FTSG: bacitracin, adaptic, telfa (several layers of telfa) secured with 5-0 prolene

3 Months followup comparing donor side to unoperated side