The Dermatome and Its Thickness Setting: What You Set Is Not What You Get

Skin grafting is a vital part of the treatment of deep skin defects resulting from burns, necrotizing fasciitis and other causes. Nowadays, Split Thickness Skin Grafts (STSGs), comprising the epidermis and a part of the dermis, are normally harvested with electric or pneumatic dermatomes. STSGs are clinically subdivided into the categories thin, medium and thick, with increasing parts of the dermis being harvested. There are, however, no widely used standard ranges for this subdivision. Some research has been done to determine the clinical advantages and disadvantages of thicker and thinner grafts [1,2]. Generally speaking, thick STSGs give better cosmetic results but suffer more from necrosis, whereas thin STSGs need less wound bed vasculature, but are less cosmetically pleasing. Tang [3] found that there are distinct clinical advantages if a surgeon can choose between thicker and thinner STSGs. For example, when vascularization of wound bed is moderate, a thinner STSG is indicated. This is to enlarge the chance of a good take of the STSG. On the other hand, when the location of the split skin transplantation requires a better quality of scar, a thicker STSG will be indicated. This, for example, might be the case when a STSG is used over a joint.