return to: Full thickness skin graft; Split Thickness Skin Graft; Reconstructive Procedures Protocols

see example of use of porcine xenograft: Case Example T1a Lentigo Maligna Melanoma Resection with Porcine Graft Reconstruction

see also: Case Example Full Thickness Skin Graft and Case Example Atypical Spitz Nevus

Note: last updated before 2010

General Considerations

1. Porcine graft
2. Stents, named after Dr. Charles Stent, are often utilized to place pressure on grafts to decrease dead space and prevent seromas and hematomas. In the past a "tie-over" bolster has commonly been used. We prefer a stapled Telfa bolster. 
   1. Tie-over bolsters are unsightly, project over surrounding skin, and weep. Use of an adjacent suction drain is also difficult due to development of air leaks.
   2. Stapled Telfa bolsters lie flush with adjacent skin and apply even pressure on graft
   3. Stapled Telfa bolsters place variable pressure depending on thickness of pad. 
   4. The stapled Telfa bolster can be successfully used in many areas including the scalp, forehead and cheek.
   5. Stapled Telfa bolsters reduces operating time

Sample operative note (modified)

Head of bed was elevated and lidocaine. 1% lidocaine with 1:100,000 epinephrine was injected into the scalp surrounding the lesion. A circular incision was marked surrounding the lesion (marked previously by suture at 12:00) with 1 cm margins. After this margin was marked, the 15 blade was used to make an incision through the dermis down to and including the galea with care to preserve the underlying pericranium. The excised specimen was measured at 2.2 x 2.2 cm. Hemostasis was achieved with pressure and electrocautery. Following this, the porcine graft was measured and was sutured into the area with 4-0 chromic. The adaptic/telfa bolster was sized and trimmed to accurately fill the defect and then applied after placing bacitracin ointment over the porcine graft, then one layer of Adaptic, then 3 layers of Telfa. The dressing was then sutured with 5-0 Prolene circumferentially in simple interrupted fashion.

References

Hoffman HT, LaRouere M.  A simple bolster technique for skin grafting. Laryngoscope 1989;99:558-559.