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East and Central African Journal of Surgery, Vol. 11, No. 1, April, 2006, pp. 108-109 Harvesting split thickness skin in areas of scarcity. Asfaw Ayele (MD) Orthopaedic surgeon, Menilic ii Hospital, P.O.Box 25165, Code 1000, Addis Ababa -Ethiopia Code Number: jb06024 Background: In the third world countries like Ethiopia the majority of Hospitals
have difficulties in harvesting split thickness skin for graft because
the proper Humby knife may not be
available and where available may be too old and out of use. In order to
circumvent such a problem the author had to use the easily available and
cheap instrument, the razorblade. The aim of this study was to evaluate
the outcome split thickness skin graft harvested using sterile razor blade
in an areas of scarcity. Introduction
In the third world countries like Ethiopia poverty, and lack of attention to the health problem makes impossible to full fill the facilities of hospitals especially of operation instruments like Humby knife for harvesting of skin for graft. Since this instrument is very expensive and not available in domestic markets, there is always a tendency of waiting for donations to meet the hospital needs. Thus we need to improvise and use appropriate technology by locally available instruments. I try to avoid this problem by using razorblade and helped a lot of patients. Patient and Methods Between August 1998 and March 2005 a total of one 108 split thickness skin graft done at Menilik ii hospital using razorblade as harvester. Out of which fifty-one were M(47%),and fiftyseven were F (53%), where the M:F was1:1.12. the mean age was30.82 with the range of 9-80 years. The etiological factors were analyzed, degloving injuries accounts sixty-four cases (59%),compound fractures and dislocations accounts for twenty-three cases(21%),post contracture release accounts ten cases(9%), post tumour resection accounts for three cases(3%) chronic leg ulcer accounts for two cases (2%), amputation stump accounts for two cases (2%), bed sore accounts one case (1%), miscellaneous soft tissue injuries accounts for three cases(3%).For all of this patients split thickness skin graft done using razorblade as harvester. Interpretation The majority of patients are between 21 &40 years of age (55%). That means the most productive age group is affected. Females are more affected than males. The less number of patients seen between one and ten years of age is due to that there is no paediatric service in our hospital. Trauma accounts for the majority of the cases for skin graft, about eighty-seven cases (80.55%). Out of which degloving injuries accounts for the majority of the cases 64/108 (59.25%). Technical description All procedures were done under general anaesthesia and method of asepsis technique at major operation theatre. Patient in supine position sterile drapes applied on the body of the patient leaving a hole on the area of donor & recipient site. Then the area of the donor site is rubbed with furacin ointment, and then the assistant must apply tension to keep the skin tight by applying skin board. The blade held by straight forceps is applied to the skin at an angle of thirty degree and start harvesting in to and fro continuous movement then the harvested skin kept in saline solution until we get the desired size. Then skin is applied to the recipient site and covered with sterile gauze and furacin ointment. The same is applied to recipient site. Results The amount of skin harvested was enough to cover the desired area. The homogeneous bleeding beneath the harvest confirms that the harvested skin is split thickness skin. There was no danger of deep bite and all the graft was well taken by the recipient. Discussion In third world countries like Ethiopia and in areas of scarcity split thickness skin for graft can be harvested by using a razorblade as an appropriate technology. The advantage of using this instrument is it is cheap and locally available, steralizable, disposeable, easy to perform, no danger of deep bite. Thus skin graft can be harvested by a razor blade in areas of scarcity. Reference
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