Blepharoplasty
Skin Graft
A skin graft involves transplanting skin from one area of the body to another to cover wounds, promote healing, and restore skin integrity.
01 - Patient Setup
03 - Post-Op Information
Pre-op Meds: Ancef, Clindamycin if PCN allergy
Anesthesia: General
Patient position: Supine
Bed position: No turn
DVT ppx: Compression boots on - working BEFORE induction of anesthesia
Side Table: N/A
Lights: Overhead only
Power: 1 bovie machine
Bovie Settings: 30/30
Preinjection: None
Prep: Chloraprep, betadine
Drapes: split drapes
Instrument sets: Plastics major set
Admission status: Varies
Estimated time: 90 min
Post-op wound care: dressing in place 3-5 days
Post-op activity restrictions: No heavy activity for 4 wks
Follow up: 1 wk
Post-Op Instructions obtain from MedConnect
04 - HY Tips
02 - Case Details
Special Instruments: Dermatome, mesher, carrier, Marcaine 0.5%, mineral oil
Devices/Implants: N/A
Hypodermic needles: 20-gauge or larger spinal needle
Syringes: 60 cc Luer-Lok syringe x 2
Drains: none unless specified
Suture: 3-0 chromic SH
Anesthesia on field: Tumescent solution on the field (500 cc of injectable LR or normal saline with 1 amp of epi
Dressing:
- Recipient site: Black VAC sponge split in half, Adaptic, extra DermaTAC tape versus ioban, hospital VAC, Mastisol
- Donor site: Mepilex Ag (standard, not the transfer dressing), ABDs, Ioban, Webril 6 in, Ace 6 in x2
Draping Tips
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Prep as wide as possible
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When toweling off the surgical field and apply drapes, maintain the wide field and not make it smaller with each additional layer
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Dr. Tom does not use any instrument to clamp movie and section (just staple drapes together) to avoid count being off
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Do not let the place the movie holder in the way of the surgeon (e.g. not on R side next to patient)
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Skin graft harvest:
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Ensure the dermatome is functioning and assembled correctly with the blade labeled "This side up" and covered with a 3-inch guard (avoid 4-inch and 2-inch guards).
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Set the thickness to 0.010 inches for Dr. Kleiber patients; increase to 0.012 inches if no tumescent is used
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Wipe off all ChloraPrep solution from the thigh with a wet lap to prevent the dermatome from sticking.
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Apply minimal oil to the donor site and dermatome gliding surface.
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Use multiple assistants to provide traction in various directions to ensure a flat surface on the thigh.
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Harvest the skin graft with the dermatome at a 30 to 45-degree angle.
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Mesh the graft to the desired ratio. Use the carrier with the dermis side up for correct placement.
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Tips for Dressing:
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Make an imprint of the VAC sponge on the recipient site and cut it to match precisely.
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Place Adaptic onto the sponge and staple it in place (skip this step for Dr. Tom, who does not use Adaptic).
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Border the recipient site with Mastisol or Duoderm if it's a moist area.
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Use Ioban to expedite taping the sponge down.