Freehand Technique to Harvest Partial-Thickness Skin to Repair Superficial Facial Defects

Abstract

In selected sites and patients, the freehand graft is a rapid and convenient method of harvesting skin. When harvested from the preauricular cheek and subauricular neck, the graft is a good match to cover sun-exposed defects of the nose and ear. The major advantages of the freehand technique are that: 1) it expands the number of potential donor sites from which to select the most compatible skin to cover facial defects; 2) it allows the surgeon to efficiently configure the graft to the desired shape and depth to conform to the cosmetic unit or defect that is being reconstructed; 3) it does not require a dermatome or other specialized instrument to perform; and 4) it achieves wound repair with good appearance and function. The freehand partial-thickness skin graft has become our preferred method of grafting superficial facial defects.

The Use of a Flexible Razor Blade in Skin Graft Harvesting

“…In most cases, the preauricular or postauricular skin is favored because they generally provide a satisfactory match for facial skin, especially of the nose and ear. 1,4 The donor areas are delineated using a marking pen and anesthetized using tumescent infiltration of 1% lidocaine with epinephrine (1:200,000 dilution). Betadyne or hebiclens is used as a topical antiseptic.…”

Score and shave technique with freehand scalpel for harvesting small split-thickness skin grafts in dermatological surgery

“…15 scalpel blade in a bevelled or vertical incision to enter the dermis and then slicing the upper dermis at a blunter vertical angle when at the desired level of the dermis to harvest the graft. They suggested that the angle allows for stabilization of the dermis as the graft is harvested, but decreases the velocity at which the graft is harvested . Our technique differs from theirs in that we use an initial vertical score to outline the size and shape of the STSG required, and use a dressing without bolster on the graft site.…”

“…2a-c) and the feet. 4 For auricular reconstruction, the sites used for harvesting score and shave STSGs included the postauricular neck and postauricular scalp areas. The donor site for the digits and feet were from the lateral thigh.…”

“…6 Snow et al described freehand scalpel harvesting in 1991. 4 They suggested using a no. 15 scalpel blade in a bevelled or vertical incision to enter the dermis and then slicing the upper dermis at a blunter vertical angle when at the desired level of the dermis to harvest the graft.…”

“…They suggested that the angle allows for stabilization of the dermis as the graft is harvested, but decreases the velocity at which the graft is harvested. 4 Our technique differs from theirs in that we use an initial vertical score to outline the size and shape of the STSG required, and use a dressing without bolster on the graft site.…”