Enhancing Lower Extremity Defect Coverage: High Viability Ultra-Thin Split-Thickness Skin Grafts Obtained from the Scalp

Abstract

Background: Repairing lower extremity defects presents challenges due to the scarcity of available local tissue. Skin grafting is a widely employed technique for addressing non-healing ulcers, improving the quality of life of patients and minimizing discomfort. However, using traditional donor sites, such as the thigh, can hinder mobility and result in noticeable scarring and pigmentation changes.

Objectives: This study aims to assess the effectiveness of a novel approach utilizing autologous ultra-thin split-thickness skin grafts (STSGs) harvested from the scalp using a disposable, commercially available razor blade named DermaBlade.

Methods: Fifteen patients (median age: 72 years, eight males and seven females) with diverse lower limb lesions, including carcinomas and ulcers of varying etiologies, were prospectively enrolled. Donor sites included the sideburn extending to the hairy temporal skin (nine cases) and hairy occipital skin (six cases). Ultra-thin skin strips (<0.2 mm thick) were obtained from the scalp through the use of the disposable flexible blade DermaBlade. The strips were positioned over the receptor area with no sutures in most cases and secured using dressings. A substantial majority of patients (90%) achieved successful graft take with no complications. Swift re-epithelialization occurred within a median of 12 days for the donor site and 24 days for the receptor site. No hair transfer or alopecic scars were noted.

Conclusions: In contrast to traditional grafting methods, DermaBlade-assisted scalp grafting yields highly viable STSGs that adhere to wound beds without the need for sutures. Notable advantages of this technique encompass rapid wound healing, minimal complications, and superior cosmetic outcomes. Furthermore, it avoids scarring and alopecia, making it a promising approach for addressing lower extremity defects.

Keywords: DermaBlade; leg; scalp; tumor; ulcer; ultra-thin strip split-thickness skin graft.

Figure 1

STSG skin grafting procedure using DermaBlade ((a–d) and (e–i) correspond to different patients). (a) Basal cell carcinoma in the lower leg. (b) Final defect after complete tumor excision. (c) Final defect size after employing staples to reduce the dimensions of the wound. (d) Strips of ultra-thin skin-obtained graft previously submerged in diluted antibiotic (cephalexin and sodium chloride 0.9%) to be placed over the defect. (e) Shaved hair from the temporal region as the donor site. (f) Scalp donor site (hairy temporal skin) immediately after obtaining ultra-thin strip STSGs with DermaBlade. (g) Grafts were placed and sutured in the defect (staples were also used). (h) Completely epithelialized wound on a leg one-month post-procedure. (i) Completely epithelialized donor site without scarring and with hair regrowth, one-month post-procedure.

Figure 2

Completely epithelialized squamous cell carcinoma after grafting STSG with DermaBlade. (a) Squamous cell carcinoma in the lower leg. (b) Immediate defect appearance after complete tumor excision. (c) Grafts are placed in the defect with no sutures. (d) Completely epithelialized wound on the leg, one-month post-procedure. (e) Scalp donor site (hairy temporal skin) immediately after obtaining ultra-thin strips with DermaBlade. (f) Scalp donor site (hairy temporal skin) days after obtaining the strips. (g) Completely epithelialized donor site without scarring and with hair regrowth, one-month post-procedure.

Figure 3

Completely epithelialized squamous cell carcinoma defect after using STSG taking from the scalp with DermaBlade. (a) Immediate defect appearance after complete excision of squamous cell carcinoma. (b) Use of DermaBlade to harvest STSG from the hairy sideburn area. (c) Scalp donor site (hairy temporal skin) immediately after obtaining ultra-thin strip STSGs. (d) Grafts are placed in the defect with no sutures. (e) Completely epithelialized wound on the leg, one-month post-procedure.

Figure 4

Completely epithelialized venous ulcer after using STSG removal from the scalp with DermaBlade. (a) Recalcitrant venous ulcer defect. (b) Scalp donor site (hairy occipital skin). (c) Grafts are placed in the defect (consequently, a compressive wound dressing was applied without suturing). (d) Receptor area after 3 days. (e) Donor occipital area after 10 days. (f) Ulcer aspect after 28 days.