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Surgical pearl: A novel technique of marking epidermal surface of the epidermal graft

 Consultant Dermatologist, Mukhtar Skin Centre, Katihar Medical College Road, Katihar, Bihar, India

Date of Submission28-Nov-2020
Date of Decision04-Mar-2021
Date of Acceptance19-Mar-2021
Date of Web Publication21-Aug-2021

Correspondence Address:
Muhammed Mukhtar,
Consultant Dermatologist, Mukhtar Skin Centre, Katihar Medical College Road, Katihar, Bihar - 854 105
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_895_20

How to cite this URL:
Mukhtar M. Surgical pearl: A novel technique of marking epidermal surface of the epidermal graft. Indian Dermatol Online J [Epub ahead of print] [cited 2021 Nov 27]. Available from: https://www.idoj.in/preprintarticle.asp?id=324185

   Problem Faced Top

The suction induced epidermal graft is flimsy and translucent which is transported with the help of glass slides, acetate sheets, spatula, syringe barrel, fine dressing gauze, gloved finger, or petrolatum-soaked sheet.[1],[2] These methods are time-consuming, and uncurling and spreading out the graft is required after harvesting the graft. The transparent glue (cyanoacrylate glue, Healex spray, fibrin glue) is used for uncurling the graft for handy use and ease in its transportation.[3] However, the glue renders the graft more translucent leading to difficulty in distinguishing the epidermal surface after excision of the blister, if the epidermal surface is not marked [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d,[Figure 1]e. Moreover, the surface identification is very crucial for the success of epidermal grafting. Keeping this in mind, a novel confusion-free strategy is advised for blister harvesting and its transportation.
Figure 1: a-e. The glued translucent blister graft harvested and transported in confusion without marking the epidermal surface of the graft with Micropore tape

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   Solution Proposed Top

On completion of the suction procedure, under asepsis, blister roof and its margin is painted sparingly (not heavily) with cyanoacrylate glue. Following this, a small piece of Micropore adhesive tape /patch (opaque, clean, not sterile but can be sterilized with ethylene oxide gas and disinfected with spray of povidone-iodine, medical spirit, and sodium hypochlorite) was made to stick (patch) on the blister rooftop. Alternative to this nonsterile tape, a small cut piece of antiseptic handyplast/band-aid can be used. After this, a blister is harvested from the edge with the tip of a hypodermic needle. The surfaces of the harvested blister graft are easily identified, and it can be handled and transported without confusion [Figure 2]a,[Figure 2]b,[Figure 2]c,[Figure 2]d. The tape sticker of small size is not removed from the graft surface as it does not hamper the grafting procedure and the graft uptake. Thus, a Micropore tape sticker on the glued blister roof is a novel technique for easy identification of the graft surface that helps in confusion-free transportation and grafting [Figure 3]a,[Figure 3]b,[Figure 3]c,[Figure 3]d. The incidence of infection is not significant in using Micropore adhesive tape on clean wound. As an alternative to Micropore, the graft roof (in tensed, deflated state) can be marked easily with a surgical pen marker with 2 consequent English letters or Arabic numbers to avoid confusion about the graft surface.
Figure 2: (a-d) The glued blister graft harvested, transported, and grafted over the site after marking with a small piece of the Micropore tape

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Figure 3: (a-d) Suction blister is harvested,lifted and regrafted over recipient site with micropore adhesive tape marker

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I acknowledge Dr. Bushra khan, M.D. (Dermatology) for her help in editing the text of this article

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Conflicts of interest

There are no conflicts of interest.

   References Top

Ashique KT, Srinivas CR. Resizing blister roof grafts for vitiligo surgery. J Am Acad Dermatol 2014;71:e39-40.  Back to cited text no. 1
Laxmisha C, Thappa DM. Surgical Pearl: Gloved finger as a transport platform for epidermal graft of suction blister. J Am Acad Dermatol 2007;57 (5 Suppl):S118-9.  Back to cited text no. 2
Mukhtar M. Surgical Pearl: 2-Octyl-cyanoacrylate for transferring suction-induced epidermal grafts. Cosmet Dermatol-Cedar Knolls 2006;19:279-82.  Back to cited text no. 3


  [Figure 1], [Figure 2], [Figure 3]


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