Abstract
Introduction
Excision of burn-injured tissue can be accomplished by a variety of means. The most commonly used tools in the burn community are straight blades of varying lengths fitted to guards of different depths. A traditional straight dermatome can also be used for excision. We describe here the use of a circular dermatome, which in addition to allowing curvilinear excision holds the promise of expediting burn excision as well.
Methods
IRB approval was obtained for a prospective study of the use of a circular dermatome device for the excision of burns. Patients with deep partial- and full-thickness burns were eligible for inclusion in the study. Eight patients undergoing nine procedures were included. The excisions were performed exclusively with the dermatome, with use of standard equipment only for smaller areas (hands/feet). The size of the dermatome, depth of excision, and time of excision with the dermatome were noted. Total operative time (recorded as “procedure start” to “procedure end”) was also recorded, as was the subsequent wound coverage material.
Results
A total of nine cases were included. The four-inch diameter blade was most commonly used, typically at depths of 25 or 30/1000thinch. The sizes of the areas excised ranged from 392cm2 to 4694 cm2. The total time of excision was short (2 to 10 minutes), and total case times varied greatly (31 to 262 minutes) due to differences in wound coverage. Excision time per cm2 was calculated in seconds due to the brevity of the excision and typically fell between 0.1 to 0.3 seconds per centimeter squared. The outlier (0.7s/cm2) was encountered early in the study and represented a challenge of technique. Cases where wound coverage was achieved with allograft or with standard split-thickness skin graft had case times of 2 to 5 seconds per square centimeter; the outlier (11s/cm2) was the result of a use of an unrelated new technology.
Conclusions
Rapid excision of a large area of burn can be accomplished with the circular dermatome. The device can also be used of course to take autograft. When the case consists completely of excision and allografting or conventional split-thickness skin grafting, the total operative time can be very short indeed. The dermatome may be beneficial additionally for longer cases where operating room time saved in excision may be used for other purposes.