Skin grafting of middle and small area deep burn wounds for functional and aesthetic recovery

AIM: To discuss the skin grafting of middle and small area deep noncervicofacial burns for optimal functional and aesthetic results. METHODS: Superficial escharectomy and eschar tangential excision were adopted for the treatment of burn wounds in the recipient sites, with normal subdermal tissues remained as much as possible and bleeding prevented tightly. Turgidization was performed by hypodermic injection of normal saline solution with low concentration of adrenaline in the donor sites. A large sheet of split-thickness skin graft (0.2-0.6 mm) was usually harvested with a Padgett dermatome, electric dermatome or free hand knife. Long axis of skin sheet was vertically laid down to the longitudinal axis of wound and the grafting was carried out without hole opened and with 3-0 silk suture. Finally, the wounds were dressed and fixed. RESULTS: The skin grafting was performed in altogether 592 cases, with recipient area of 1%-30% TBSA and average of (11.2±2.7)% TBSA. Survival rate of transplanted skin sheets on all patients was more than 95% and the cases with 100% survival of transplanted skin accounted for 91.9% of all cases. 1-year or longer follow-up results were as follows: skin tissue in recipient site appeared full, soft and smooth with slight pigmentation, but without obvious hypertrophic scar; the limb joints could freely move; surface of skin donor sites showed a little more coarse than that of normal skin, with obscure pigment deposition. CONCLUSION: By strengthening wound management, improving and proficiently grasping skin harvesting technology, selecting suitable donor site, we could obtain an ideal functional and aesthetic results for both donor and recipient sites in the transplantation of a large sheet of thicker or thin split skin graft without hole opened for middle to small area deep burn.