OR / Prep · Plastic & Reconstructive Surgery · open
You’re scrubbing into
Split-thickness skin graft
Why are we operating?
Borrowing the top layers of skin from a healthy site to resurface a wound that cannot close itself; the graft survives on the bed it lands on, which is the whole art.
Indication: Burns after excision, large wounds with a healthy granulating bed, donor coverage after flap harvest.
Read the imaging first
Practice before you scrub
Size the burn, find the danger
A house fire: burns to the anterior trunk and one whole arm, charted on arrival. (Fictional educational case.)
- Honest area assessment is treatment: the fluid formula inherits every charting error, in both directions.
- Circumferential deep burns are compartment syndromes: the escharotomy done possibly-early beats the one done certainly-late.
The operation in 4 steps
01Preparing the recipient bed
The wound is debrided to healthy, bleeding, uninfected tissue; haemostasis is meticulous.
02Harvesting the graft
A dermatome shaves a calibrated split-thickness sheet, classically from the thigh, leaving the donor dermis behind.
03Meshing and application
The graft may be meshed to expand it and let exudate escape, then it is laid on the bed, trimmed, and fixed at its edges.
04Dressing and immobilisation
A pressure dressing or vacuum bolsters the graft; the part is immobilised, with the first inspection deferred for days.
Anatomy you need
The organ itself: a graft is a shaving of this surface, and the donor site heals from what is left behind.
What can go wrong
Watch it done
Split-thickness skin graft
Harvest with the dermatome, meshing and fixing the graft, and the donor site.
Source: Children's Hospital Colorado · Watch on YouTube
Conceptual teaching for learners preparing to observe and assist under supervision, not operative instructions. Five minutes from now you should know why this operation exists, what its shape is, and which structures it is designed not to injure.