Simultaneous two-layer harvesting of scalp split-thickness skin and dermal grafts for acute burns and postburn scar deformities

Abstract

BackgroundThe scalp, an excellent donor site for thin skin grafts, presents a limited surface but is rich in stem cells. The purpose of this study was to test a double harvesting procedure from the scalp and to evaluate the capacity of the dermal layer.MethodsTwo layers corresponding to a split-thickness skin graft (SSG) and a split-thickness dermal graft (SDG) were harvested from the scalp using a Zimmer dermatome during the same procedure. Healing of the scalp donor site, reason for recipient site grafting, and the percentage of graft loss were evaluated.ResultsFourteen patients, comprising six men and eight women with a mean age of 34.2 years, were treated according to our protocol. The most common reason for a recipient site graft was a postburn scar deformity (10/14 patients). The mean area of scalp SSGs was 151.8 cm2. The mean area of scalp SDGs was 88.2 cm2. The mean healing time of scalp donors was 9.9 days. The only donor complication was a tufted scar deformity.ConclusionsSkin defects in the scalp of donors healed faster and led to less scarring than defects at other donor sites. Scalp SDGs needed 10 days for adequate epithelization. The scalp was the best donor site for SSGs and SDGs for burn reconstructive patients.

A systematic review of the scalp donor site for split-thickness skin grafting

“…The use of dermatomes with a depth setting of less than 0.016 inches showed higher early complication rates than the total early complication rate in five articles [4][5][6]10,23] and higher late complication rates than the total late complication rate in eight articles among 15 articles [2,5,6,[10][11][12]21,23]. Among the six articles [3,7,13,19,24,28] that reported the relevant data, a dermatome depth setting of 0.016 inches or more showed a higher early complication rate than the total early complication rate in one article [7], a higher late complication rate than the total late complication rate in one article [3], and higher early and late complication rates than the total early and late complication rates in one article [13]. Overall, the rate of early and late complications did not seem to be related to the depth setting of the dermatome.…”

“…The mean age of the patients in the 20 articles that included that information was 23.6 years. The mean age of the patients was 5.13 years in the nine articles with children [3,[8][9][10]12,14,22,26,27], 27.67 years in the seven articles with children and adults [5][6][7]11,18,23,28], and 59.08 years in the four articles with adults. Seven articles [2,4,13,16,20,21,24] did not mention the mean age (Table 1).…”

“…Two articles did not use tumescent solution [24,26]. The depth setting of the dermatome was less than 0.016 inches in 17 articles and 0.016 inches or more in seven articles [3,7,13,14,19,24,28]. Three articles [6,8,9] did not mention the depth setting (Table 1).…”

“…There was only a single harvest or crop in 12 articles [5,9,13,16,17,[19][20][21][23][24][25]28], and single or multiple harvests in 15 articles. Two articles [19,28] reported simultaneously harvesting the scalp skin and a dermal split-thickness graft.…”

“…Alopecia after scalp skin harvest occurred in 4.74% of patients (145 of 3,062) in 18 articles, while nine articles did not mention the proportion of alopecia after scalp skin harvest [2,4,9,16,19,21,23,24,28]. Five patients developed occipital alopecia due to pressure sores [22].…”