haywanchiudpm

Follow-up for the previous post to show the final photos. I harvested from the ipsilateral thigh for the split thickness skin graft. In general, when wounds are 100% granular, they’re ready for skin graft, does not require skin substitutes at that point. This took very well and healed in a month, some of the edges struggled to heal the final bits hence the 2 month healing after STSG.

This post shows a case of a man in his 40s who developed gangrenous wounds due to walking on hot concrete, with history of diabetes and microvascular disease. He developed a dorsal foot wound after 2nd toe amputation that needed a wide debridement with I&D, and delayed wound closure. He eventually was discharged but needed to be admitted again due to pulmonary issues and anasarca, which subsequently lead to the 3rd toe becoming partially gangrenous from the reduced oxygenation. At this point he had a large dorsal wound that was granulating, but plantar foot wounds that were slow to heal. The dorsal foot wound was skin graft ready, but the plantar wounds were not. Also due to his pulmonary issues and widespread edema, I figured it’s best to reduce donor site morbidity and avoid a large split thickness skin graft donor site. Since he needed wound care on the plantar foot wounds for a while anyways, it didn’t give him much benefit to heal the dorsal foot wound rapidly, so I decided a pinch graft would be a good middle option. It’ll help generate separate islands of skin that will start their own center for secondary wound healing, reducing the overall time to heal otherwise albeit not as fast as a STSG would. My post-op protocol for a pinch graft is:

1st week: xeroform gauze kerlix ACE left alone
2nd week: change dressings 1-3x per week with xeroform betadine gauze (depending on size of wound and drainage). Weekly debridements to keep the granular tissue biofilm free. Keep this going until healed.
Same as above for donor site minus the debridement

The pinch grafts are described without fixation, just wrap with a dressing. They do migrate a tiny bit, but they usually take pretty well. Donor site heals quickly too even if you went to subq level in the center bit since it’s a variable thickness harvest. This is a good option for speeding up epithelialization when parts of the foot are not yet ready for STSG and still needs wound care. I harvested mine from the thigh, but if you have scope issues, just harvest from the calf, or even near the wound itself.