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BackgroundNon-melanoma skin cancer (NMSC) is correlated with high morbidity and mortality in solid-organ transplant recipients (OTR) and it appears after a mean interval of 8 to 10 years. Prophylactic treatments are still required to prevent the development of NMSC. This study aims to investigate whether dermatome shaving reduced the occurrence of keratotic skin lesions in OTRs.MethodsA retrospective study was conducted. One thousand and twenty-four patients who had a split-thickness skin graft due to NMSC excision were identified in the Central Denmark Region and the Region of Southern Denmark between 1996 and 2011. Eleven of these patients were OTRs at the time of split-thickness skin grafting and were included in the study. The patients were examined for keratotic skin lesions, representing suspected premalignant lesions, on the donor area of the split-thickness skin graft, recipient area and two corresponding control areas. Epidemiological and medical parameters for each patient were registered via medical records and through patient interviews.ResultsThe average time between split-thickness skin grafting and clinical examination was 6.2 years (1.1–16.8). The occurrence of keratotic skin lesions were lower in the donor area compared to both of the control areas (Wilcoxon matched-pairs signed-rank test, p = 0.024, respectively, p = 0.019).ConclusionsDermatome shaving reduced the occurrence of keratotic skin lesions in OTRs and might prevent the development of field cancerization and NMSC.Level of Evidence: Level III, therapeutic study.

Sir, Splitor partial-thickness skin grafting is one of the oldest procedures performed in plastic surgery [1] and is the most commonly used procedure for reconstructing defects of various sizes and anatomical locations [2]. When defects are large, it is frequently not possible to provide wound coverage with one split-thickness skin graft alone due to limitations in the width of the graft that can be harvested with an electric dermatome or hand-held knife. In these circumstances, it may be necessary to use two or more separate sheets of skin graft in order to resurface the wound. When this is necessary, the technique most commonly employed is to place the two skin grafts side-by-side on the wound so that their edges are apposed, and these grafts are then sutured, stapled or glued together. We have observed that this technique can cause hypertrophy and ridging or delayed wound healing at the junction between the two grafts, as can be seen in Fig. 1. However, we have found that this junctional ridging can be avoided by laying down the two grafts side-by-side with an overlap of 3–5 mm and leaving the junction between the two grafts unsecured. This is demonstrated in Fig. 2 (left panel). The two grafts are secured to the wound edges with fast-absorbing sutures. The excess overlapped skin at the junction between the grafts eventually sloughs off (much like the excess graft along the margins of the wound), and when the graft takes, there is little or no evidence that there were ever two separate grafts on the wound bed, and junctional ridging is thus avoided. This is demonstrated in Fig. 2 (right panel), which is the same patient 4 months postoperatively. To our knowledge, this technique has hitherto not been reported in the literature. We have employed this technique in over fifty patients with large skin defects resulting from

Multiple split skin grafts are often required for large wounds such as burns and in necrotizing fascitis. Harvesting multiple skin grafts seamlessly without leaving islands of ‘normal skin’ between adjacent donor sites can be difficult, especially for junior plastic surgery trainees. A seamless donor site helps maximize graft harvest and avoids a ‘patch-work appearance’. We suggest a simple method to avoid this problem when using a three inch Zimmer® dermatome blade.

The object of the study was to investigate the effect of EMLA cream when used as an anaesthetic for the debridement of ulcers and wounds. The cream was applied to a fresh, standardized wound caused by a dermatome, to an ulcer which was to be revised and for simultaneous split-skin grafting to both donor site and recipient area to be debrided. The effect on wound healing, the plasma concentrations of lidocaine and prilocaine and the analgesic effect following the application of EMLA to the ulcer and to both ulcer and donor site were studied. The study showed that EMLA cream when topically applied has a sufficient analgesic effect for revision of an open ulcer and can be used concomitantly for both revision of the ulcer and cutting of the split-skin graft. The application of EMLA cream to the fresh wound, or to the recipient area prior to cleaning, did not cause any clinical signs of a delayed healing at the applied areas compared to the control sites.

A dermatome for experiments with small animals in which split skin grafts are required has been introduced. The dermatome is inexpensive and it is easy to remove skin of correct thickness. It can also be used to create comparable raw areas in an experimental model using small animals.