| INNOVATION |
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| Year : 2021 | Volume
: 14
| Issue : 1 | Page : 107-109 |
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Split-thickness skin graft harvest under local anesthetic: A single pass technique
Ardit Begaj, Christian M Asher, Alexander E Hamilton
Department of Plastic Surgery, Royal Preston Hospital, Preston, United Kingdom
Correspondence Address:
Ardit Begaj
Department of Plastic Surgery, Royal Preston Hospital, Preston PR2 9HT.
United Kingdom
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/JCAS.JCAS_66_20
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Adequate local anesthetic, in harvesting a split-thickness skin graft (SSG), traditionally involves multiple passes of a needle across the length and width of the marked donor site.
We describe a technique using hyaluronidase to uniformly anaesthetize an SSG donor site with one injection, in one pass, of one needle.
1. Preop application of EMLA cream/AMITOP to the donor site
2. Mix 10 mL 1% lidocaine solution with Adrenaline 1:200,000 with 1 vial of Hyaluronidase 1500 units. The mixture is buffered with 1 mL 8.4% sodium bicarbonate to neutralize acidity and minimize pain.
3. Mark out the SSG donor site
4. Using a 27-G long needle (sterican), enter perpendicular to the skin in the middle of the proximal aspect of the donor site. Inject some local anesthetic subdermally, creating a mound.
5. Change the angle of the needle to 180° and continue to inject the remaining anesthetic along one half of the width of the donor site.
6. Using a rolled 4 × 4 swab, apply firm advancing pressure to distribute the mound across the remaining width and length of marked donor site.
7. As the mound advances, the hyluronidase/anesthetic mixture will distribute uniformly across the donor site within the same plane. The skin blanches secondary to the adrenaline during its distribution.
The technique described is a fast, reproducible way to improve patient comfort through the elimination of repeated passes of a needle, distributing the anesthetic uniformly across the donor site, and facilitating the acquisition of an SSG of uniform thickness |
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