Tie-over Bolster Dressings May Not Be Necessary to Secure Small Full Thickness Skin Grafts

Abstract

We have found tie-over bolster dressings and basting sutures to be unnecessary in our series of small FTSG. This technique saves time and material and minimizes handling of the graft.

Grafts in Dermatologic Surgery

“…Once all sutures are in place, ointment is applied to the graft site, and a nonadherent material, such as Telfa, is placed over the graft and the immediate surrounding skin. A bolster dressing is then typically applied to further protect and immobilize the graft; however, some surgeons dispute this need 39,40. The tie‐over bolster is the classic dressing for FTSGs in which individual sutures are used to secure a pressure dressing over the graft.…”

A Prospective Evaluation of the Incidence of Complications Associated With Mohs Micrographic Surgery

“…Bolster dressings were not used for skin graft repairs, as data have suggested that they may not be necessary to secure full-thickness skin grafts to reduce the chance of graft necrosis. 15,16 Also, attention was given to the previously reported adverse relationship between tobacco use and the outcome of cutaneous surgical procedures. 17 To minimize the potential development of tissue necrosis in our patients, we requested that patients limit cigarette smoking and the use of other tobacco products for 1 week before surgery and for the immediate postoperative period (1-2 weeks).…”

Complications of tissue ischemia in dermatologic surgery

“…Blind placement of a basting suture may nick a blood vessel in the wound base, leading to hematoma or seroma. Additionally, if the bolster provides too much pressure, the blood supply to the graft may be compromised leading to graft loss (31,32). Compression dressings, basting sutures, and bolsters are no substitute for meticulous intraoperative hemostasis.…”