The use of small deep grafts in the repair of surface defects

It has been said that the results obtained by the use of small deep grafts are never satisfactory; that small deep grafts, often incorrectly called pinch grafts, should never be the method of choice; that by the use of these grafts the donor site is made useless as the source of other grafts, and that the method is a surgical error. My experience has been that if small deep grafts are properly cut and are really small deep grafts; if they are used in the proper situation on a surface which is suitable for them; if they are properly spaced; if they are properly dressed; if the after-care is as it should be—the healing will be stable, strong and permanent, and there is no type of graft which gives more uniformly satisfactory results. Furthermore, small deep grafts will in many instances take on surfaces on which no larger graft could take. If the best results are to be obtained with small deep grafts, several points must be observed. The granulating surface on which the grafts are placed should be healthy, clean, flat, firm and rose pink in color. The grafts should be cut without unnecessary trauma, should include the full thickness of the skin at its center and should be no larger than 5 mm. in diameter. In cutting, a narrow rim of undisturbed epidermis should be left between the little pits, and in this way a large number of grafts can be obtained from a very small area of skin. In fact, a greater raw area can be healed from a smaller skin source than by any other method. The grafts should preferably be placed on the granulations with a space of about 5 mm. between them, although frequently excellent results are obtained when the spaces are greater. They should be pressed down firmly so that the thin edges will uncurl and so that every portion of the graft will be in close contact with the granulating surface. The grafts should be immobilized until the new blood supply is assured, and this is best accomplished by the closed method of dressing. My own experience and that of many other surgeons during nearly thirty years has convinced me that the method is that of choice in a great many instances, and I feel that those who have not had good results, either do not know how to use this type of graft or do not take the trouble to use it properly. In my own work I use small deep grafts constantly, with the greatest satisfaction, and find the method indispensable when dealing with large losses of surface tissue and in solving some of the complicated problems of wound healing