Full thickness skin graft harvested from the inside of the upper arm
This is Richard Allen at the University of Iowa. This video demonstrates harvesting of a full thickness skin graft from the inside of the upper arm. This patient has a history of a facial cleft with subsequent cicatricial ectropion and lower lid retraction. A template is made of the defect with telfa. This is then transferred to the area of harvest which is the inside of the upper arm. This is a nice place for harvest as the skin is not hairbairing. A number 15 blade is then used to make an incision through the skin. The graft is then harvested with Westcott or Steven scissors. The excison is performed so that very little fat is excised with the graft. The graft should ultimately consist of only dermis and epidermis. Closure of this site is performed with deep interrupted sutures. I usually like to use a 4-0 monocryl suture. A running 5-0 prolene suture is then externally on the skin. The graft is then sutured into position with interrupted and running 5-0 fast absorbing suture. The eyelid is then placed on stretch with a Frost suture, a bolster is placed over the graft, and the eyelid patched for a week.