An Innovative Method of Repeated Tie over Dressing for Fixation of skin Graft

Reconstruction of any soft tissue defect is managed as per conventional reconstructive ladder. The options range from healing by secondary intention, primary closure, skin graft and flaps. Skin graft is one of the commonest methods of reconstruction. For proper take of skin graft, the graft needs to be adherent to the wound bed for first few days. The fixation should not allow any hematoma or seroma formation under the graft.1 This is achieved by fixing the skin graft with tie over dressing using multiple silk sutures. Repeated tie over dressing is needed in the settings where graft needs to be inspected frequently.1 Four patients having recurrent and huge keloids on anterior chest wall in the presternal region were referred from radiation oncology department for possible excision and postoperative radiotherapy. All these patients have previously undergone multiple treatments of their keloids in the form injections and local excisions with out any benefit. The patients were accepted by radiation oncology and were found candidates for immediate radiotherapy after excision of keloid. In all patients keloids were excised and the soft tissue defect was covered by full thickness skin grafts harvested from groin. The skin grafts were immobilized by tie over dressing in an innovative way. In this method the normal saline bottle used for irrigation was cut at its neck (Figure 1). The skin graft was fixed by cyanoacrylate skin glue and tie over dressing using 2-0 silk sutures. All the patients gave a written informed consent for their inclusion in the study. The identity of all the persons in the study was kept confidential. Department of Plastic Surgery, King F M C, Riyadh, Saudi Arabia