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The Use of the Scalp as a Donor Site for Ultrathin Split-thickness Skin Grafts

Puja Panwar, James L Griffith, Mario V Mitkov, Goldberg H Leonard

Texas A&M University College of Medicine

Introduction: Autologous, ultrathin split-thickness skin grafting (uSTSG) is a common and effective closure technique for surgical defects located on areas with limited nutritional support, like the ears. uSTSG are composed primarily of epidermis with minimal dermis and are less than 0.15mm thick. A portion of cases will exhibit prolonged donor site morbidity lasting over one year post-operatively like skin atrophy, dyspigmentation, scarring, and erythema. This donor site morbidity may be cosmetically unacceptable, uncomfortable, and psychologically distressing when harvested from typical donor sites such as the inner arm, thigh and buttocks. Therefore, the scalp may be more appealing, since hair regrowth conceals donor site erythema, dyspigmentation, and atrophy, while the high density of follicular units provides faster re-epithelialization. Here we aim to endorse the use of the scalp as the primary graft donor site in Mohs reconstruction. Methods: All patients were Mohs patients undergoing reconstruction in a dermatological surgery clinic. We harvest uSTSG from the occipital and temporal-parietal scalp with a double-edge razor blade. Using a freehand technique, the blade is held between the thumb and the middle finger, and a forward or side to side sweeping motion is performed. The blade should be slightly flexed with little downward pressure to minimize the thickness of the graft and maintain a plane above the follicular bulb. If performed correctly, the graft should appear semi-translucent. We performed a short retrospective chart review of our donor site grafting technique. Results: In a retrospective chart review of 45 cases performed at our facility, we observed no cases of alopecia. In fact, hair growth was seen at all 2-week post-operative checks. Conclusion: STSG’s are often associated with donor site morbidity, an issue that can be minimized by using the scalp as the donor site. Because of the site’s rich vascularity and abundance of dermal appendages, the scalp heals on average within 6 days, compared to 2 weeks for other sites. Furthermore, alopecia can be avoided with ultrathin DermaBlade techniques, if the bulge region of the hair follicle is kept intact. Overall, the scalp provides an excellent donor site for uSTSG, since the wounds can be concealed and need minimal care to achieve excellent cosmetic outcomes. This practice is a useful technique that can increase the versatility of a surgeon’s reconstructive methodology.

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