see also: Full thickness skin graft
Porcine Xenograft (Skin Graft)
return to: Full thickness skin graft or Split Thickness Skin Graft
see example of use of porcine xenograft: Case Example T1a Lentigo Maligna Melanoma Resection with Porcine Graft Reconstruction
Case Example Full Thickness Skin Graft and Case Example Atypical Spitz Nevus
return to: Reconstructive Procedures Protocols
GENERAL CONSIDERATIONS
- Porcine graft
- 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.
- 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.
- Stapled Telfa bolsters lie flush with adjacent skin and apply even pressure on graft
- Stapled Telfa bolsters place variable pressure depending on thickness of pad.
- The stapled Telfa bolster can be successfully used in many areas including the scalp, forehead and cheek.
- 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.
Reference:Hoffman HT, LaRouere M. A simple bolster technique for skin grafting. Laryngoscope 1989;99:558-559.