Silicone Removal
  Inspect and Prepare Neodermis
  Harvesting the Thin Epidermal Graft
  Attaching the Thin Graft
  Epidermal Graft Post-Op Care

Epidermal Grafting - Summary
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In this section, you have learned:

  • Following successful formation of the Neodermis, typically at around 21 days, the patient is returned to surgery where the silicone layer is removed and a thin epidermal autograft 0.004-
    0.006 inches (0.1016 - 0.1524 millimeters) is placed.
  • Staples or sutures are removed and the silicone is peeled back carefully from the edges with forceps. A spatula or blunt instrument may be used (if necessary) to perform the separation. Difficult removal may indicate incomplete Neodermis formation.
  • Assess the availability of donor sites. Estimate the size of the epidermal graft and determine if expanded graft will cover INTEGRA Template. If not, then staged or delayed epidermal grafting
    is necessary.

  • Remove excess granulation tissue at seams of INTEGRA Template at edges including any contaminated or necrotic tissue or areas of incomplete take
  • Debride surface of neodermis by lightly rubbing with a gauze pad if necessary. Control any bleeding. The Neodermis does not bleed easily, but may "blush" after debridement.

  • Prepare donor site by infusion with saline to facilitate harvesting. Harvest a thin epidermal graft 0.004-0.006 inches (0.1016 - 0.1524 millimeters). Grafts thinner than 0.004 inches may result in incomplete "take" as few live epidermal cells are transferred. Grafts thicker than 0.008 inches are more likely to leave a residual meshed appearance. The graft should be attached as per normal surgical unit protocol, taking the following into account: The graft is more fragile than conventional split-thickness grafts. The thinness of the graft makes orientation easy to confuse (Curl under indicates correct orientation). Carefully smooth out the graft. Saline can be used to float the graft into position. Interstices should be larger than 2mm. Secure by stapling edges and center as appropriate. Dress and care for epidermal graft sites using the protocols typically used for thick split-thickness skin grafts.

  • Similar to dressing INTEGRA Template sites, build dressings in layers and immobilize joints in a flexed position. If the epidermal graft seems to "disappear", obtain cultures. In some cases, this is typically the result of the graft being too thin or the presence of infection. If negative, continue to dress normally. Engraftment and confluence should occur within 21 days. If positive for infection, administer antibiotics and continue to monitor closely. If engraftment or confluence has not occured within 21 days, then re-grafting may be necessary.

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