Split-thickness Skin Graft Harvest under Local Anesthetic: A Single Pass Technique

Adequate local anesthetic, in harvesting a split-thickness skin graft (SSG), traditionally involves multiple passes of a needle across the length and width of the marked donor site. We describe a technique using hyaluronidase to uniformly anaesthetize an SSG donor site with one injection, in one pass, of one needle. 1. Preop application of EMLA cream/AMITOP to the donor site 2. Mix 10 mL 1% lidocaine solution with Adrenaline 1:200,000 with 1 vial of Hyaluronidase 1500 units. The mixture is buffered with 1 mL 8.4% sodium bicarbonate to neutralize acidity and minimize pain. 3. Mark out the SSG donor site 4. Using a 27-G long needle (sterican), enter perpendicular to the skin in the middle of the proximal aspect of the donor site. Inject some local anesthetic subdermally, creating a mound. 5. Change the angle of the needle to 180° and continue to inject the remaining anesthetic along one half of the width of the donor site. 6. Using a rolled 4 × 4 swab, apply firm advancing pressure to distribute the mound across the remaining width and length of marked donor site. 7. As the mound advances, the hyluronidase/anesthetic mixture will distribute uniformly across the donor site within the same plane. The skin blanches secondary to the adrenaline during its distribution. The technique described is a fast, reproducible way to improve patient comfort through the elimination of repeated passes of a needle, distributing the anesthetic uniformly across the donor site, and facilitating the acquisition of an SSG of uniform thickness.