Advancements in Skin Grafting: Development and Applications of a Novel Multi-Blade Dermatome for Concurrent Split-Thickness and Dermal Graft Harvesting A technical note and proof of principle

Abstract

This investigation delineates the evolution and prospective utilisations of an innovative multi-blade dermatome, designed for the concurrent harvesting of a conventional split-thickness skin graft (STSG) and additional dermal graft within the same surgical harvest. Historically, the extraction of dermal grafts has encountered substantial technical impediments, contributing to its limited acceptance and utilisation in clinical practice. The prototype dermatome, introduced in this technical note and demonstrative of a proof of principle application, offers a technical resolution that could facilitate the more extensive adoption of dermal grafting techniques. The dermal segment of an STSG, obtained as a second graft, confers four notable advancements: Firstly, employing solely the dermal component for grafting and repositioning the uppermost skin layer to the donor site markedly diminishes donor site morbidity. Secondly, owing to its elasticity, the dermal graft reduces the need for meshing, thereby enhancing cosmetic outcomes. Thirdly, utilising both the uppermost skin later and deeper dermal layer for the recipient site can reduce donor site areas. Fourthly, the dermal segment of the graft can serve as a dermal matrix in reconstructive procedures, potentially reducing the need for an allogenic dermal matrix and possibly obviating the subsequent STSG, as the dermal graft may heal independently, eliminating the need for an additional conventional STSG. The findings of this study, predicated on the application of a first-generation multi-blade dermatome on four cadavers, demonstrate the feasibility of extracting at least two distinct grafts with pre-determined thicknesses in a single, technically less challenging, surgical harvest procedure. In conclusion, this proof-of-concept research elucidates the feasibility of a multi-blade dermatome, capable of simultaneously yielding at least one conventional STSG and one dermal graft, thereby simplifying the skin graft harvesting. Although these preliminary investigations were conducted on human cadavers, the results hold promise for the development of multi-blade dermatomes and represent a significant advancement in skin graft harvesting. Further research is imperative to refine the prototype and to broaden our comprehension of the potential applications of dermal grafting in various clinical scenarios, where dermal grafts may prove beneficial.