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Split-thickness skin grafts remain central to the strategy of burn wound treatment. The dressing used to cover the donor wound site has a significant effect on healing parameters. The purpose of this study was to compare split-thickness skin graft donor site reepithelialization under Xeroform and Jelonet dressings. A dermatome was used to cut two consecutive strips of skin from 25 paired donor sites on the thigh, calf, or back of 19 participants. Standardization of the harvest method was achieved by using the same surgeon to harvest the compared skin graft strips, with attention to consistency of dermatome skin-thickness setting, downward pressure, and angle of dermatome approach. A strip of Xeroform or Jelonet was applied to one of each pair of wounds. Epidermal and dermal thickness was measured from biopsy specimens cut at the midpoint of each split-thickness graft strip. The day of final dressing separation was declared the day of complete donor reepithelialization (healing). The mean healing time for Xeroform and Jelonet was 10.4 +/- 2.6 days (n = 25) and 10.6 +/- 2.8 days (n = 25) (p = 0.76) at sites cut to a mean depth of 0.23 +/- 0.08 mm and 0.23 +/- 0.09 mm (p = 0.89), respectively. There was no correlation between graft thickness and healing time for sites dressed with Xeroform (r = 0.17) or Jelonet (r = 0.02). Donors sites reharvested 10 to 21 days after a prior harvest healed an average of 3.1 days earlier than virgin sites (8.4 +/- 1.6 versus 11.5 +/- 2.6 days, p < 0.001), although reharvested grafts were on average 0.05 mm thicker (p = 0.10). The mean thickness of reepithelialized donor-site epidermis (0.13 +/- 0.04 mm, n = 30) was found to be twice the thickness of virgin epidermis from the same sites (0.06 +/- 0.02 mm, n = 38, p < 0.001). Thirty-six grafts harvested with dermatomes set to cut 8/1000 inch (0.20 mm) deep ranged from 0.12 to 0.42 mm thick, with only eight of these grafts measuring within +/-10 percent of the desired thickness setting. Before donor dressing separation, Xeroform and Jelonet dressings were judged to be more comfortable by nine patients and one patient, respectively, whereas no difference was detected by six patients. The authors now use Xeroform as the preferred donor dressing.

Background: Harvesting split skin grafts in rodents has proven to be challenging, as the presence of panniculus carnosus tissue in rodent skin causes high flexibility and mobility of the upper skin layer. Thus, fixation is indispensable for granting precise manipulation during the grafting process. All techniques established in the literature achieve stability by dissecting a subcutaneous pocket beneath the panniculus carnosus. In this article, the authors present a method that excludes inflicting additional wounds other than that to the donor site but takes advantage of the elasticity of rat skin. Methods: A customized sturdy support plate is held laterally beside the skin area where the split skin is to be cut. The skin is mobilized, pulled over the support plate, and fixed with the nondominant hand on the bottom of the device. Using a dermatome, the split skin graft is cut on the metal plate, which provides a flat surface to permit a precise harvesting process. Results: A total of 208 split skin grafts were harvested, of which nine had to be rejected. The average time to perform a split skin graft on one animal, not considering preparation time, was 2 minutes. All of the harvested grafts were 2 × 2.5 cm (0.79 X 0.98 inch), with a mean thickness of 0.3 mm. Reharvesting could be performed on postoperative day 7. Conclusions: Using this new standardized method, grafts of equal size and thickness can be obtained rapidly. It is cheap and highly reproducible and can be carried out by a single surgeon. It provides a rapid healing process with fewer complications and immensely reduced stress for the animals.

Background: Laser therapy is the optimal approach for treating port-wine stains, but whether it is effective for patients with facial dermatomal port-wine stains and Sturge-Weber syndrome is undetermined. This project aimed to verify the incidence of Sturge-Weber syndrome and glaucoma within the population, compare the response in syndromic and nonsyndromic patients with facial dermatomal port-wine stains to laser, and determine the treatment response in relation to dermatome and color. Methods: The authors retrospectively reviewed 874 patients with facial port-wine stains (203 displayed a dermatomal pattern). Pretreatment and posttreatment photographs were assessed clinically and recorded on a statistically reliable percentage gradient. Results: Sturge-Weber syndrome was diagnosed in 30 patients. Twelve patients had glaucoma, with the port-wine stains involving the ophthalmic (V 1 ) division of the trigeminal nerve. The highest proportion of patients with glaucoma came from those with involvement of the maxillary (V 2 ) and/or mandibular (V 3 ) division of the trigeminal nerve. No patients had Sturge-Weber syndrome with V 3 port-wine stains alone. After laser therapy, only 45 percent of syndromal patients and 55 percent of nonsyndromic patients had a satisfactory outcome (>50 percent) in color and size reduction of dermatomal port-wine stains. Conclusions: The incidence of Sturge-Weber syndrome was 3 percent in patients with a facial port-wine stain. There was an increased risk of Sturge-Weber syndrome with involvement of V 1 port-wine stains and no risk with involvement of V 3 port-wine stains alone. Laser treatment produced unsatisfactory outcomes in patients with facial dermatomal port-wine stains. V 3 port-wine stains responded best and V 2 worst to laser.

Restoration of sensibility in the paraplegic patient is the optimal therapy for the management and prevention of debilitating pressure sores. In patients with an absence of sensibility below the L3 spinal level, a locally transposed arterialized neuromyocutaneous gracilis flap may be uniquely utilized for ischial restoration of sensibility. Two patients with meningomyelocele-induced ischial pressure sores underwent local innervated neuromyocutaneous gracilis flap transposition to insensate areas from below the anatomic level of recipient insensibility. A 10-year follow-up revealed maintenance of sensibility in the flap and spread of sensibility to adjacent insensate areas with no evidence of pressure sore recurrence. Cadaver dissection and clinical Xylocaine injection demonstrated that the cutaneous sensory innervation to this flap is by means of a consistent sensory branch from the deep neurovascular pedicle, which coincides with the L1-L3 dermatome.

This study was undertaken to prospectively evaluate breast sensibility before and after reduction mammaplasty with a new, objective, and quantitative neurophysiologic method based on the anatomic knowledge of breast innervation and the congruent areas of dermatomal maps. An innovative application of dermatomal somatosensory evoked potentials was used to study the breast regions of 42 healthy women, bilaterally. The areas stimulated in each breast were the superior quadrant, the nipple-areola complex and the medial and lateral quadrants, and the inferior quadrant; these areas correspond to T3, T4, and T5 dermatomes, respectively, following the accepted concepts of segmentary innervation of the skin. The two groups of 21 patients each were formed according to breast size: group I comprised small-breasted, unoperated controls (brassiere cup size A or B); group II comprised macromastia patients (brassiere cup size C or greater) who presented to a general plastic surgery department for breast reduction surgery. First the authors established the normal range of latency and amplitude in the dermatomal somatosensory evoked potentials for the five areas stimulated in patients with small breasts and compared these parameters with those obtained from patients with macromastia. Then, after the macromastia patients underwent reduction mammaplasty using the McKissock technique, the authors compared the postoperative sensory values with their own preoperative values and with those from the small-breasted group. Using dermatomal somatosensory evoked potentials, they found that small breasts were statistically more sensitive than large breasts, which concurs with studies in the literature that use other methods to evaluate breast sensibility. They also found that after breast reduction, the macromastia patients presented statistically significant improvement in breast sensibility in relation to their own preoperative latency and amplitude values, with no statistical difference in amplitude with respect to the small-breasted group; this finding suggests that after breast reduction, sensibility similar to that of the small-breasted group can be considered a possibility. Furthermore, in comparisons of each of the five areas stimulated, there was no significant difference in values within the small-breasted group or within the macromastia group before or after surgery; this supports a possible overlap between adjacent dermatomes. This innovative application of dermatomal somatosensory evoked potentials is an objective, quantitative, and noninvasive method that has allowed the authors to evaluate breast sensibility and to compare postsurgical sensory outcomes.

Rhinophyma is a disfiguring soft-tissue hypertrophy of the nose. It is an uncommon disease that primarily affects Caucasian men in the fifth to seventh decades of life. Nine cases from the authors' series and a comparison of results following various treatment modalities are presented. Eight of the patients were Caucasian and one was African American. Excision of the diseased tissue with a scalpel or Goulian dermatome using loupe magnification provided the safest means of preserving the underlying sebaceous gland fundi that permit spontaneous re-epithelialization with the least scarring.

Patients with mild forms of tuberous sclerosis may request cosmetic treatment of skin hamartomas. Treatment may consist of planning of an elevated shagreen patch with a Reese dermatome and/or laser treatment of facial angiofibromas. These precise patients, i.e., patients with a forme fruste of tuberous sclerosis, are more likely to have pulmonary involvement than patients with the usual complete disease form. A chest x-ray should be obtained in these patients to rule out pulmonary involvement. Half the patients with pulmonary involvement of tuberous sclerosis die an avoidable death from spontaneous pneumothoraces. Positive-pressure ventilation during anesthesia in these patients should be avoided or monitored closely.

A 60 percent degloving injury involving the torso and lower extremities of an 8-year-old boy is described. Successful management employed the use of a new trilaminar skin coverage technique. With the avulsed flap still attached to its bed, a 0.14-inch split-thickness graft of epithelium and superficial dermis is raised with a power-driven dermatome. From the same harvest site, one level deeper, a second layer consisting of split-thickness dermis (0.14 inch) is taken. Both the first and second layers are meshed and expanded. The remaining degloved flap is excised and, on a sterile bench, defatted to produce a third layer of deep dermis. In our case, this third layer was ultimately lost, but it functioned well as a temporary biologic dressing. Depending on donor-site morbidity, other potential applications of this method (i.e., major burn injuries) may be feasible.

The Davol dermatome, which was introduced in 1965, had several shortcomings in clinical application. In order to increase the efficiency of this machine, changes in the motor and drive linkages of the power handle have been made. In the clinical use of the new dermatome, ;we have found significant improvement in its application. The stalling characteristics of the dermatome have been improved and more satisfactory grafts are now obtainable. This article presents some of the technical data involved in the new drive linkage and motor complex.

In using the Padgett-Hood dermatome, a scalpel blade can be utilized as a substitute for the calibrator. The thickness of the scalpel blade shows very little discrepancy in comparison with 1/1000 in statistically, so it is better to check the indicator with this method than by empirical sense.

Psoriasis is currently considered an incurable skin disorder whose etiology is unknown. Psoriasis involves the epidermis and epidermal-dermal junction of interfollicular skin. This paper reports one patient in whom a partial-thickness excision of a psoriatic scalp was done, permitting reepithelialization from the deep dermal adnexae. A 4 1/2-year follow-up documents a long-term remission of the psoriasis of the scalp.

The method proposed for rapid skin grafting of mass casualties need not be limited to large numbers but is most ideally suited for this type of work. It has been used extensively by the author in individual cases and found to yield the best results of any rapid method of skin grafting tried.