Through-and-Through Mattress Suturing Versus Tie-Over Dressing in Full-Thickness Skin Graft Reconstruction

Abstract

Objective: To compare the outcomes of securing full-thickness skin grafting (FTSG) with through-and-through mattress suturing versus the classic tie-over and pressure dressing and identify the associated risk factors of graft failure. Methods:A single-institution, retrospective case series of patients who had undergone excision of head and neck skin lesions requiring FTSG over a 10-year period was reviewed. Results:In total, 128 FTSG reconstructions were performed. The follow-up period ranged from 1 to 192 weeks. The observed graft take rate was 86.4%.There was no significant difference in the outcome when the surgical fixation technique was compared. Age, sex, or defect area did not affect the graft take rate. Smoking and the use of anticoagulants were not found to be contributory factors to graft failure. Conclusion:Simple through-and-through mattress suturing provides adequate graft take, while minimizing tissue handling of the graft and reducing surgical time in comparison to the traditional tie-over and pressure technique.

To Tie or Not to Tie-Over Full-Thickness Skin Grafts in Dermatologic Surgery: A Systematic Review of the Literature

“…Fifteen articles met the inclusion criteria involving only skin surgery (for details see Table S1, Supplemental Digital Content 4, http://links.lww.com/DSS/A423. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Three studies used randomization, [28][29][30] and 4 studies compared a no tie-over dressing with a tie-over dressing but did not always specify the materials used for the bolster. 27,29,31,33 Two articles mentioned both STSGs and FTSGs and did not subdivide the graft take per technique.…”

“…[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Three studies used randomization, [28][29][30] and 4 studies compared a no tie-over dressing with a tie-over dressing but did not always specify the materials used for the bolster. 27,29,31,33 Two articles mentioned both STSGs and FTSGs and did not subdivide the graft take per technique. 28,38 Because the ratio of FTSGs used in these articles (over 80%) was high, they were found suitable to include in this review.…”

“…28,38 Thirteen studies used only FTSGs. [25][26][27][29][30][31][32][33][34][35][36][37]39 The graft defect size was described in different measurements of length (mm and cm) or surface area (mm 2 and cm 2 ) and varied from 8 mm in length (smallest) 34 to 52.4 cm 2 (largest area). 25 Nine studies reported the use of additional antibiotics: systemic 35 and local.…”

Full-thickness skin graft fixation techniques: A review of the literature

“…Four observational studies compared the tie-over dressing to quilting/mattress suturing. [ 1 65 66 67 ] These studies included 181 grafts in total, and no significant differences were found between groups for graft take, hematoma/seroma formation, and infection.…”

“…In most studies graft success was measured by clinical assessment of the healing graft, but there was heterogeneity in this grading. This included grading into good, moderate, and poor:[ 74 ] defining partially taken as those with >60–<100% graft take rate;[ 65 ] rating graft take as 0%–100%;[ 68 ] and separating graft take into groups, such as 0%–24%, 25%–49%, 50%–74%, and 75%–100%, with the latter group defined as complete take. [ 63 69 ]…”