Case 1: Split-skin to lower leg

Previous defect is marked in a 5 mm margin.

Donor site, medial right thigh, is shaved.

The donor site is disinfected and an area equal to the size of the primary defect is drawn.

A skin graft is harvested using an electric dermatome. Donor sites usually heals within 7 days. After harvesting, an adrenalin-soaked gaze is applied, to stop bleeding.

The skin is re-excised.

The re-excision includes the entire skin down to muscle facia. Make sure sufficient hemostasis has been performed. If blood/fluid is allowed to build up underneath the graft, revascularization can’t happen

The skin graft is meshed, to prevent blood/fluid to build up and for the graft to cover a larger area. This can also be done using a mesher.

The graft is sutured to the wound edges, take note of the meshing. The graft should always be sutured in graft to skin direction to better adapt the graft.

Non-adherent dressing, in the case Nitro- and Jelonet, is applied

Tie-over dressing/bolster, in this case foam, is applied and sutured to the skin surrounding the defect. The point of this is to create a light pressure on the skin graft, keeping it in place and further preventing hematoma or seroma, without causing necrosis.

Donor site is bandaged.

Lower leg with the recipient site is further compromised using a compression sock.