DOI: 10.1097/SAP.0b013e3180a6f443
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PMID: 17721233
Issn Print: 0148-7043
Publication Date: 2007/09/01
An Alternative to Bolus Tie-over Dressing for Full-Thickness Skin Grafts for Conchal Cavity Defects
Ulrich M. Rieger; Martin Haug; Gerhard Pierer
Excerpt
We present a reliable and easy-to-use technique as an alternative to bolus tie-over dressing for fixation of full-thickness skin grafts1,2 in reconstruction of defects of the conchal cavity. We use silicone sheets (Medtronic, Jacksonville, FL) for fixation and dressing. After resection of squamous or basal carcinoma infiltrating cartilage of the conchal cavity, a simple way of defect closure is the use of full-thickness skin grafts with countertransplantation on the back skin side of the auricle, provided that an outer frame of cartilage stays intact. Silicone sheets are cut to size and shape of the defect, using a template, and applied to the graft on a layer of Jelonet (Smith & Nephew) (Fig. 1). Another silicone sheet is placed on the opposite side of the defect, lying on top of intact skin on the back side of the auricle (Fig. 2). Both silicone sheets and the graft are then transfixed through the graft with 3 or 4 sutures to secure the graft in place. We found that through the relative rigidity of the silicone sheets and the counterforce of the silicone sheet on the back side of the auricle, bending of the auricle can be avoided, which is advantageous to the conventional tie-over dressing in parts of the auricle after resection of cartilage.
We found that with this technique both, trainees and consultants achieved excellent graft take results (100%). Additionally, the method can be easily used on one's own without assistance because the graft stays in place easily. Both dressing application and removal are quick and the procedure is easy to learn and teach.
We suggest considering this technique for its reliability and its convenience to use.
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