Full thickness skin graft from retroauricular area
This is Richard Allen at the University of Iowa. This video demonstrates the harvesting of a full-thickness skin graft from a retroauricular site. A template has been made of the eyelid defect with a clear drape. The template is then transferred to the area behind the left ear. The edges of the template have been marked with a marking pen. The markings are then completed. The area has been previously been anesthetized with Lidocaine with epinephrine. A 15 blade is then used to make an incision through the skin. The graft is then excised with Westcott or Steven's scissors. Bleeding is controlled with the monopolar cautery. After harvesting, the area is widely undermined with the monopolar cautery. The donor site is then closed with deep interrupted 4-0 Vicryl sutures. These sutures are placed to bury the knot deep. Usually about 5-6 sutures are placed. The needle on the suture is a P-2 needle which is useful in tight spaces. The external skin sutures are placed with a funning 5-0 Prolene suture. These sutures are removed at one week when the patient returns. Fortunately, this incision is well hidden behind the ear. Before the graft is placed, the remaining subcutaneous fat should be excised. This is performed by placing the graft on your index finger and using the back of the curved scissors for better feel.