Hand knife versus powered dermatome: current opinions, practices, and evidence

Area of Science:

• Plastic Surgery
• Surgical Techniques

Background:

• Surgeons have differing preferences for powered dermatomes versus hand knives in split-thickness skin graft harvesting.
• The rationale behind these preferences and supporting evidence is not well-established.

Purpose of the Study:

• To explore the reasoning behind surgeons' preferences for skin graft harvesting instruments.
• To investigate the existing evidence supporting the use of powered dermatomes or hand knives.
• To identify and address misconceptions regarding these surgical tools.

Main Methods:

• A postal survey of 30 British plastic surgery units was conducted.
• Medicolegal departments were consulted.
• A literature review was performed to gather evidence on skin graft harvesting instruments.

Main Results:

• Out of 238 surgeons surveyed, 145 (61%) preferred powered dermatomes, citing perceived better graft and donor site quality.
• 95 (40%) respondents believed using a hand knife when a powered dermatome was available could lead to litigation.
• No evidence was found to support these clinical or medicolegal beliefs.

Conclusions:

• Numerous misconceptions exist regarding the choice of instruments for skin graft harvesting.
• Surgeons' instrument choice should be based on their own assessment for optimal results, not on unfounded opinions.
• Evidence does not support a universal preference for powered dermatomes over hand knives.