Outpatient Minced split-thickness skin grafts for burn wounds
Sanches-Pinto, Débora Cristina1; Souza-Gomez, David1; Monteiro-Jr, Araldo1; Gemperli, Rolf1; Eriksson, Elof2.
1- Plastic Surgery and Burn Division, Hospital das Clínicas, School of Medicine, University of São Paulo-Brazil
2- Harvard Medical School, Boston, MA –USA

Objective: we wanted to explore the option of minced split-thickness skin grafting under local anesthesia in outpatients. The costs of grafting under general anesthesia, keeping the patients at the hospitals, are very high. We also want to see if the technique is easy to performer, is painful and consider the benefits of a smaller donor site.

Methods: nine burned areas were grafted. We used a non-powered, hand-held, dermatome and a non-powered, hand-held mincer was used for each procedure. The skin was expanded 10 times after mincing. The split-thickness skin graft was 12/ 1000 inch (.3mm) thick and was minced into .8 mm x .8 mm pieces. The minced skin was applied evenly to the wound surface with a spatula without regard to the orientation of the individual pieces (dermal side up or down). The grafted areas were covered first with an interface of multiperfurated silicone dressing and then with a 3mm thick layer of hydrogel over the burn wounds. A foam controlled hydration dressing was placed on top of this. Every two days post operatively, the foam and the hydrogel were changed without disturbing the interface dressing.

Results: The nine burn wounds were completely reepithelialized at 2 weeks. There were no adverse effects from the any of the treatment components. The patients referred no pain and were very pleased with the small donor sites and the fact that this could be done on an outpatient basis.

Discussion /conclusion: Compared with the others methods we used before, always keeping the patients at the hospital we found this new method easy to perform and concluded in this limited study of micrografting that it seems to be a useful and simple technique for outpatient skin grafting with a high success rate at a lower cost. We are already doing on bigger prospective study