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

Adequate local anaesthetic, in harvesting a split thickness skin graft (SSG), involves multiple passes of a needle across the length and width of the marked donor site. We describe a technique using hyaluronidase to uniformly anaesthetise an SSG donor site with one injection, in one pass of one needle. Mix 10mls 1% Lidocaine solution with Adrenaline 1:200,000 with 1 vial Hyaluronidase 1 Unit/ml solution. The mixture is buffered with 1 ml NaHCO3 to neutralise acidity and minimise pain. Mark out the SSG donor site Using a 27G long needle (sterican), enter perpendicular to the skin in the middle of the proximal aspect of the donor site. Inject some local anaesthetic subdermally, creating a mound. Change the angle of the needle to 180 degrees and continue to inject the remaining anaesthetic along one half of the width of the donor site. Using a rolled 4x4 swab, apply firm advancing pressure to distribute the mound across the remaining width and length of marked donor site. As the mound advances, the hyluronidase/anaesthetic 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, distribute the anaesthetic uniformly across the donor site, and facilitate the acquisition of an SSG of uniform thickness The technique described is a fast, reproducible way to improve patient comfort through the elimination of repeated passes of a needle, distribute the anaesthetic uniformly across the donor site, and facilitate the acquisition of an SSG of uniform thickness