A Literature Review of the Lubricants Used in Dermatome-Assisted Split-Thickness Skin Graft Harvest

Background: Split-thickness skin grafts (STSGs) are utilised to close wounds which cannot be closed by primary closure. Dermatome-assisted STSG harvest utilises a lubricant to control friction, which facilitates graft harvest. Many different lubricants are used during graft harvest, although little research has been conducted to identify the optimal lubricant. Furthermore, new techniques such as Meek grafting are incompatible with commonly used oil-based lubricants. Method: A literature search was conducted, following the PRISMA protocol. 173 records were screened with 6 included in this study. We also reviewed the literature on lubricants in other biotribological systems including shaving. Results: We found support for numerous lubricants, including: mineral oil, catheter gel, chlorhexidine, saline and ultrasound gel. Evidence consisted of expert opinions, and one blinded comparative review. There was no consensus on the optimal lubricant, and we did not find evidence that lubricant compatibility with Meek grafting had been assessed. Conclusions: Presently, lubrication choice in STSG harvest lacks a scientific basis, and further research is needed to design a bespoke, Meek-compatible lubricant which considers only four of Engelhardt's characteristics (1. cost-effectiveness; 4. lubrication; 6. no side effects; 8. practicability) to be essential. This should be followed by a blinded trial of lubricants.